Clinical Documentation Integrity & Claims Auditor

Job Description

A bit about this role:

The role of Clinical Documentation Improvement Auditor is a key part of Devoted’s Quality & Risk Adjustment strategy. This position helps to ensure the accuracy of diagnostic information and coding (ICD-10 CM) by performing audits and medical chart reviews. The Clinical Documentation Improvement Auditor will perform these duties in accordance with ICD-10 CM coding guidelines, internal coding protocols and CMS guidance. This role will assist with provider education, guidance and training related to diagnostic documentation and coding. This role requires some domestic travel to meet with and educate providers and support staff in office locations.

Responsibilities will include:

• Perform Medical Record audits based on organizational priorities. These can include both concurrent Clinical Documentation Improvement (CDI) work flows aswell as retrospective auditing. Coding reviews and/or Audits may lead to the addition, deletion, adjustment or confirmation of diagnoses.
• Review of audit results with CDI Manager. Assist in creating and communicating provider and vendor education regarding trends and areas of opportunity regarding compliant coding practices.
• Assist CDI Manager by making recommendations for process improvements to further enhance coding quality goals and outcomes.
• Handle other related duties as required or assigned, including provider educationand training and working with vendor partners.
• Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance.

Desired Skills and Experience:

• BA/BS in Nursing preferred but not required.
• 3+ years as an outpatient CDI or 5+ years in risk adjustment coding/auditing.
• CPC or CRC certification through AAPC or CDI or CCS certification through AHIMA.
• Prior CPT coding a plus.

Salary range: $58,000 - $85,000 per year

Competencies and Attributes:

• Strong analytical and problem solving skills.
• Strong oral and written communication skills.
• Strong organization and time management skills.
• Ability to work independently.
• Ability to multi-task.

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.