Clinical Documentation Integrity, Claims Auditor

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

📋 Description

• Execute audits of medical records in line with organizational priorities, which include concurrent Clinical Documentation Improvement workflows and retrospective audits.

• Perform coding reviews and audits that may lead to the addition, removal, modification, or confirmation of diagnoses.

• Discuss audit findings with the CDI Manager.

• Aid in developing and disseminating educational materials for providers and vendors regarding coding trends and compliant coding practices.

• Support the CDI Manager by providing recommendations for process enhancements aimed at improving coding quality objectives and results.

• Manage related responsibilities, such as educating and training providers, and collaborating with vendor partners.

• Conduct meetings and provide education to providers and support staff at various office locations during domestic travel.

• Stay updated on ICD-10-CM coding guidelines, AHA Coding Clinic recommendations, and CMS Risk Adjustment directives.

⛳️ Requirements

• BA/BS in Nursing is preferred but not mandatory.

• A minimum of 3 years of experience as an outpatient CDI or 5 years in risk adjustment coding/auditing.

• CPC or CRC certification from AAPC or CDI or CCS certification from AHIMA.

• Previous experience in CPT coding is advantageous.

• Strong analytical and problem-solving abilities.

• Excellent oral and written communication skills.

• Exceptional organizational and time management capabilities.

• Ability to work autonomously.

• Capability to handle multiple tasks simultaneously.

• Stay informed on ICD-10-CM coding guidelines, AHA Coding Clinic recommendations, and CMS Risk Adjustment directives.

• Some travel within the country is necessary.

• Full-time employees qualify for the total rewards package.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium costs.

• Generous paid time off policy.

• Monthly stipend of $100 for mobile or internet expenses.

• Stock options available to all employees.

• Bonus eligibility for all positions except for Director and above; commission eligibility for Sales roles.

• Parental leave program.

• 401K program offered.