Clinical Documentation Integrity Specialist - QA
2 Months ago • 3-5 Years
Quality Assurance
Job Description
The Clinical Documentation Integrity Specialist - QA (CDI-S QA) will audit the work of Clinical Documentation Integrity Specialists and Coders to ensure complete, accurate, and compliant diagnostic documentation and coding. This role ensures alignment with ICD-10-CM guidelines, CMS risk adjustment methodology, and payer requirements. The specialist will maintain the integrity of documentation review workflows, improve field-level education effectiveness, provide feedback to CDI staff, identify trends and training needs, and collaborate with leaders. Occasional practice travel may be required, but most work is remote. The ideal candidate is detail-oriented, quality-focused, and proficient in Google Suite tools.
Good To Have:
- Prior CDI QA, audit, or compliance role experience
- Successful outpatient coding and billing track record
- Self-directed and solution-oriented
- Strong understanding of value-based care principles
- Excellent communicator to practices and internal teams
- Ability to collaborate across teams for buy-in
- References demonstrating integrity and accountability
Must Have:
- Bachelor's degree or equivalent experience
- Certified Professional Coder (CPC) or equivalent
- CDEO, CRC, or CCDS-O certification
- Minimum 3 years CDI or 5+ years risk adjustment auditing
- Understanding of ICD-10-CM, HCC risk adjustment, compliance
- Strong written and verbal communication skills
- Ability to identify documentation gaps and impacts
- Experience with EHR systems and chart abstraction
- Skilled in synthesizing audit results for education
The CDI Specialist -QA (CDI-S QA) will serve as a quality assurance leader by auditing the work of Clinical Documentation Integrity Specialists (CDIS) and Clinical Documentation Integrity Coders (CDI-Cs), ensuring complete, accurate, and compliant diagnostic documentation and coding in alignment with ICD-10-CM guidelines, CMS risk adjustment methodology, payer requirements, and Aledade’s internal standards. This role plays a critical part in maintaining the integrity of documentation review workflows and improving the effectiveness of field-level education. The CDI-S QA will provide structured feedback to CDI staff, identify trends and training needs, support quality improvement initiatives, and collaborate with clinical, coding, and operational leaders. Occasional travel to practices may be required, with most work performed remotely. The ideal candidate is detail-oriented, quality-focused, and fluent in—or willing to master—Google Suite tools.
Primary Duties:
- Conduct routine and focused audits of CDIS and CDI-C chart reviews to assess accuracy, compliance, completeness, and consistency. Identify documentation improvement opportunities and recommend corrections. Summarize audit findings and provide actionable feedback to CDI team members and leadership.
- Analyze trends across audit results to identify team- or market-level gaps. Collaborate with CDI leadership to design and refine quality standards, protocols, workflows, and internal guidance materials. Contribute to continuous quality improvement initiatives.
- Support and deliver internal training and calibration sessions for the CDI team. Assist in onboarding new team members by validating their documentation and coding reviews. Serve as a subject matter expert on CMS HCC risk adjustment and documentation integrity best practices.
Minimum Qualifications:
- Bachelor’s degree in a healthcare-related field or equivalent experience required
- Current certification as a Certified Professional Coder (CPC), or equivalent
- CDEO (AAPC), CRC (AAPC), or CCDS-O (ACDIS) certification required
- Minimum of 3 years recent experience in Clinical Documentation Integrity or 5+ years of risk adjustment auditing experience
- Deep understanding of ICD-10-CM coding, HCC risk adjustment, documentation compliance, and value-based care principles
- Strong written and verbal communication skills, with experience delivering feedback to peers or staff.
- Demonstrated ability to identify documentation gaps and explain the clinical and financial impacts of inaccurate coding
- Experience with EHR systems, chart abstraction, and outpatient clinical workflows
- Skilled in synthesizing audit results to drive education and process improvement
Preferred Key Skills and Abilities:
- Prior experience in a CDI QA, audit, or compliance oversight role
- Successful track record in outpatient coding and billing through previous experience
- Self-directed and solution oriented
- Strong understanding of value-based care principles, particularly as they relate to the impact of clinical documentation and coding on risk adjustment payment models in value-based contracts
- Strong understanding of outpatient coding and billing
- Solution-oriented individual who can execute tactical continuous quality improvement work to deliver results in value-based contracts
- Excellent communicator who can articulate the impact of documentation and diagnosis initiatives to Aledade ACO member practices and their key staff (e.g., office managers, practice billers, etc.), and internally within the company.
- Ability to work collaboratively across Aledade clinical and non-clinical teams to gain buy-in and implement key documentation improvement initiatives
- References demonstrating high degree of integrity and professional accountability
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