Audit Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform retrospective and concurrent audits on the work of CDIQ Specialists to ensure accurate documentation review, compliant query generation, and proper capture of SOI, ROM, CC/MCC, and HCC.

• Analyze missed opportunities that impact reimbursement, quality reporting, and patient outcomes.

• Work collaboratively with physicians and caregivers to facilitate appropriate reimbursement and clinical severity for DRG-based payer patients.

• Assess compliance with organizational workflows, policies, and industry standards.

• Maintain audit tools, scoring methods, and documentation related to audits.

• Offer tailored feedback and create educational plans based on audit results.

• Engage in the onboarding and mentoring of new CDQI personnel.

• Present educational sessions on documentation, coding, regulatory changes, and best practices.

• Collaborate with the Physician Advisor to identify documentation opportunities and emerging trends.

• Track program performance metrics, including query rates, response rates, agreement rates, accuracy scores, case mix index impact, and CC/MCC capture rates.

• Protect PHI, medical records, audit documentation, and company data while adhering to HIPAA and relevant standards.

• Complete assigned audits within specified timeframes and generate actionable audit findings along with educational feedback.

⛳️ Requirements

• Minimum of 5 years of experience in CDI and/or auditing.

• At least 3 years of clinical experience in an academic medical center.

• RN or BSN with CCDS or CDIP certification required.

• Successful completion of CDI skills competency assessment is mandatory.

• Proficient in using various EMRs and CDI software such as Epic, Cerner, 3M, Iodine, etc.

• Ability to operate in a professional, efficient, and positive manner.

• Strong organizational, teamwork, and communication abilities.

• Must reside in the United States.

• This position is not eligible for employment sponsorship.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• 401k savings plan with matching contributions.

• Paid time off (PTO) plan.

• Floating holidays and paid holidays.

• Flexible work arrangements.

• Opportunities for career advancement and professional development.