CDQI Audit Specialist

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

📋 Description

• Perform retrospective and concurrent audits of the work done by CDIQ Specialists to ensure documentation accuracy, compliant query generation, and correct capture of SOI, ROM, CC/MCC, and HCC.

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

• Work in collaboration with physicians and caregivers concerning reimbursement and clinical severity for DRG-based payer patients.

• Assess adherence to organizational workflows, policies, and industry standards.

• Oversee audit tools, scoring methodologies, and audit documentation.

• Offer tailored feedback and create educational plans based on the results of audits.

• Engage in onboarding and mentoring processes for new CDQI staff members.

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

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

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

• Ensure the protection of PHI, medical records, audit documentation, and company data in accordance with HIPAA and regulatory standards.

• Complete designated audits within the specified timeframes and produce actionable findings and educational feedback.

⛳️ Requirements

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

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

• RN or BSN qualification with CCDS or CDIP certification.

• Must successfully pass the CDI skills competency assessment.

• Familiarity with various EMRs and CDI software, including Epic, Cerner, 3M, and Iodine.

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

• Strong skills in organization, teamwork, and communication.

• Must be eligible to work in the United States.

• This position does not qualify for employment sponsorship.

🏝️ Benefits

• Comprehensive total rewards strategy.

• Post-offer health screenings and vaccinations as mandated by clients.

• Reasonable accommodations for individuals with physical and mental disabilities.

• Protections under equal employment opportunity laws.