Clinical Documentation Integrity & Claims Auditor

Job Description

A bit about this role:

The Clinical Documentation Integrity (CDI) & Claims Auditor will report to the manager, Clinical Documentation Improvement as part of the Practice Operations team. The CDI And Claims Auditor is a key part of Devoted’s Quality & Risk Adjustment strategy and claims cycle processes. This position ensures the accuracy of diagnostic information and coding (ICD-10 CM) by performing audits and medical chart reviews. Additionally, this role ensures that claims submitted on behalf of Devoted Medical are accurate, complete, and compliant with ICD-10 CM guidelines, internal protocols, and CMS guidance.

Responsibilities:

• Medical Record Audits: Perform audits based on organizational priorities, including concurrent CDI workflows and retrospective auditing.
• Coding Validation: Conduct reviews that may lead to the addition, deletion, adjustment, or confirmation of diagnoses.
• Provider Queries: Initiate queries for documentation clarification to ensure the highest level of clinical accuracy.
• Innovation: Utilize and review AI tools and "Human-in-the-Loop" outputs to support modern auditing processes.
• Education & Trends: Assist in creating and communicating provider and vendor education regarding trends and opportunities in compliant coding practices.
• Process Improvement: Collaborate with the CDI Manager to make recommendations that enhance coding quality goals and outcomes.
• Continuous Learning: Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and CMS Risk Adjustment guidance.

Required Skills and Experience:

• Required Certifications: CPC or CRC (AAPC) or CDIP/CCDSR or CCS (AHIMA).
• Clinical/Coding Background: 3+ years in outpatient CDI or 5+ years in risk adjustment coding/auditing.
• Tech Savvy: Experience with AI Tools, Copilots, and Google Suite.
• Bonus Points: Prior CPT coding experience is a plus.

Competencies and Attributes:

• Strong analytical and problem-solving skills.
• Excellent oral and written communication skills for provider education.
• Ability to work independently and manage multiple tasks in a fast-paced startup environment.

Salary: $58,000 - $90,000 base salary annually

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.