Clinical Documentation Auditor

2 Months ago • 3 Years +

Job Summary

Job Description

As a Clinical Documentation Auditor, you will review AI-generated and provider-entered encounter notes to ensure coding accuracy, clinical validity, and regulatory compliance. Your responsibilities include conducting audits, providing feedback to providers and coders, and protecting clients against payer takebacks and OIG findings. You will perform chart auditing applying coding guidelines, performing dual coding, and clinical validation. Additionally, you will maintain audit logs, flag potential coding errors, create feedback reports, and support external payer audits. The job also involves recommending improvements and participating in projects.

Must have:

Apply ICD10CM, CPT, HCPCS, and CMS E/M guidelines.
Maintain audit logs in the compliance repository.
Achieve interrater reliability and error rate.
Mastery of ICD10CM & CPT conventions, modifiers, HCCs.
Detect documentation gaps and pattern anomalies.
Comfortable auditing AI generated notes and suggesting prompt tweaks.

Perks:

Night differential: 10% of base for shifts past 10 p.m.
Performance bonus up to 10% tied to accuracy & TAT KPIs.

5 skills required

5 skills required for this role

Add these skills to join the top 1% applicants for this job

sql

excel

pivot-tables

internal-audit

quality-control

Job Details

Job Description

Position Title: Clinical Documentation Auditor
Location: Metro Manila / Greater Manila Area, Philippines (hybrid)
Department: Documentation Audit & Compliance
Reports to: Coding Manager – PH Operations
Employment Type: Fulltime | Exempt

Role Summary

As part of Neolytix’s Documentation Audit Program, the Clinical Documentation Auditor reviews AI generated (NeoScribe™) and provider entered encounter notes to verify coding accuracy, clinical validity, and regulatory compliance. You will perform concurrent and retrospective audits, deliver actionable feedback to providers and coders, and safeguard clients against payer takebacks and OIG findings.

Key Responsibilities

Focus Area	Typical Tasks
Chart Auditing	• Apply ICD10CM, CPT®, HCPCS, and CMS E/M guidelines to 25–35 charts per shift. • Perform dual coding and resolve interrater discrepancies within 24 hours. • Conduct clinical validation to confirm medical necessity of all up coded services.
Compliance & Quality	• Maintain immutable audit logs in the compliance repository. • Flag potential upcoding/down coding, cloned notes, and diagnosis procedure mismatches. • Achieve ≥ 95 % interrater reliability and ≤ 3 % overall error rate.
Feedback & Coaching	• Create chart specific feedback and trend reports for providers and CDI coaches. • Participate in 15minute microlearning huddles; share specialty specific insights.
Data & Reporting	• Update audit dashboards (Power BI) with accuracy, denial, and turnaround metrics. • Support external payer audits by packaging requested documentation within SLA.
Process Improvement	• Recommend AI prompt or template refinements to reduce recurring documentation gaps. • Contribute to Lean/Six Sigma projects that improve throughput or reduce rework.

Required Qualifications

Education: Associate’s or Bachelor’s degree in Nursing, Health Information Management, or equivalent clinical discipline.

Certification (at least one active): CPC, CCS, COC, CIC, RHIA/RHIT, or CCDS.

Experience: 3 + years U.S. professional fee and/or facility coding, including at least 1 year in a formal audit or QA capacity.

Regulatory Knowledge: Deep familiarity with CMS E/M 2023+ guidelines, HCC risk adjustment, OIG CPG, HIPAA privacy & security.

Technical: Hands on with at least one major EHR (Epic, athenahealth, eClinicalWorks) and an encoder (3M, TruCode, Optum). Excel pivot tables; comfort navigating BI dashboards.

Language: Excellent written and spoken English (minimum CEFR C1).

Essential Skill Sets

Skill Category	Specific Competencies
Coding & Clinical Acumen	• Mastery of ICD10CM & CPT® conventions, modifiers, HCCs. • Ability to interpret clinical terminology across multiple specialties (e.g., ortho, GI, cardiology).
Analytical & Detail Orientation	• Detect subtle documentation gaps and pattern anomalies. • Root cause analysis of denial trends and coder variance.
Technology Proficiency	• Comfortable auditing AI generated notes and suggesting prompt tweaks. • Basic SQL or Power Query skills to slice audit datasets (nice to have).
Communication & Coaching	• Write concise, constructive feedback that providers will act on. • Confident presenting findings on video calls with U.S. clinicians.
Compliance Mindset	• Uphold separation of duties (no production based incentives). • Protect PHI and follow zero defect documentation standards.
Time & Self Management	• Meet 48hour audit turnaround and daily production targets. • Adapt to U.S. Central time overlap and rotating specialty queues.