Clinical Documentation Integrity & Claims Auditor
Core
Ensure accuracy of diagnostic information and coding (ICD-10 CM) through audits and medical chart reviews to support quality and risk adjustment strategies.
Role type
Clinical Documentation Integrity & Claims Auditor
Builds
Accurate claims submissions compliant with ICD-10 CM guidelines and CMS guidance
Domain
Healthcare / Medical Coding & Risk Adjustment
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10 CM coding, medical record auditing, provider query management, AI tool utilization, coding guidelines knowledge
Preferred skills
CPT coding experience
Technologies
AI tools, Copilots, Google Suite
Responsibilities
Perform concurrent CDI workflows and retrospective auditing, conduct coding validation reviews, initiate provider queries for documentation clarification, review AI tool outputs, create provider education materials, collaborate on process improvement recommendations
Seniority
Mid-level, hands-on IC
