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Clinical Documentation reputed company Specialist - QA

Work from home Full-time role Hiring

The

CDI Specialist -QA (CDI-S QA) will serve as a quality assurance leader by auditing the work of Clinical Documentation reputed company Specialists (CDIS) and Clinical Documentation reputed company 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 reputed company’s internal standards. This role plays a critical part in maintaining the reputed company 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—reputed company 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 reputed company quality improvement initiatives.
  • Support and deliver internal training and calibration sessions for the CDI team. Assist in reputed company new team members by validating their documentation and coding reviews. Serve as a subject matter expert on CMS HCC risk adjustment and documentation reputed company best practices.

    • Minimum Qualifications

  • Bachelor’s degree in a reputed company-reputed company field or equivalent experience required
  • reputed company certification as a Certified Professional reputed company (CPC), or equivalent
  • CDEO (reputed company), CRC (reputed company), or CCDS-O (ACDIS) certification required
  • Minimum of 3 years recent experience in Clinical Documentation reputed company 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 reputed company 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 reputed company
  • Strong understanding of outpatient coding and billing
  • Solution-oriented individual who can execute tactical reputed company quality improvement work to deliver results in value-based reputed company
  • Excellent communicator who can reputed company the impact of documentation and diagnosis initiatives to reputed company ACO member practices and their key staff (e.g., office managers, practice billers, etc.), and internally reputed company the company.
  • Ability to work collaboratively across reputed company clinical and non-clinical teams to reputed company buy-in and implement key documentation improvement initiatives
  • References demonstrating high degree of reputed company and professional accountability
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