Clinical Documentation Integrity & Claims Auditor
Core
Conduct concurrent and retrospective chart audits to validate diagnostic information and ICD-10-CM coding accuracy, ensuring complete and compliant clinical documentation for risk-adjustment initiatives.
Role type
Clinical Documentation Integrity & Claims Auditor
Builds
Accurate medical records and compliant claims for healthcare providers
Domain
Healthcare / Medical Coding & Risk Adjustment
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10-CM coding, clinical documentation review, provider query initiation, CMS risk-adjustment guidance, AI-assisted auditing tools, Google Workspace
Preferred skills
CPT coding, process improvement, provider education
Technologies
ICD-10-CM, CMS guidelines, AI auditing tools, Google Workspace
Responsibilities
Perform medical record audits (concurrent and retrospective), validate diagnostic information and coding accuracy, initiate provider queries for clarification, utilize AI-assisted auditing tools, identify coding trends and documentation gaps, support provider education on compliant coding, partner on process improvements, ensure claims alignment with guidelines
Seniority
Mid-level, hands-on IC
