Clinical Documentation Integrity Coding Auditor

Summary

Join Honest Health as a Clinical Documentation Integrity Coding Auditor and conduct comprehensive audits of clinical documentation and medical coding to ensure compliance. Analyze medical records to identify discrepancies and coding errors, collaborate with CDI specialists and healthcare providers, and provide education and training on coding guidelines. Prepare detailed audit reports, present findings to management, and communicate coding updates. Contribute to optimal reimbursement, regulatory compliance, and improved documentation practices. This role requires a high school diploma or equivalent, a preferred degree in HIM or related field, and a relevant coding certification (CCS, CCS-P, CPC, CPMA, or CRC). Three or more years of coding experience and Medicare Advantage Risk Adjustment in an outpatient setting are necessary. Prior CDI experience is highly desirable.

Requirements

• A high school diploma or equivalent is required
• Must hold a Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Risk Coder (CRC) credential
• 3+ years of coding experience and Medicare Advantage Risk Adjustment in outpatient healthcare setting
• Extensive knowledge of medical coding systems and guidelines, including ICD-10-CM, CPT, and HCPCS Level II coding
• Experience working with clinical documentation improvement (CDI) programs and familiarity with CDI best practices
• Solid understanding of healthcare reimbursement methodologies and regulatory compliance requirements
• Strong analytical and critical thinking skills, with the ability to identify patterns, trends, and areas for improvement
• Excellent communication and interpersonal skills to collaborate effectively with healthcare professionals and coding staff
• Proficient in using electronic health record (EHR) systems, coding software, and other healthcare technology platforms
• Proficient computer skills
• Excellent communication skills, both verbal and written
• Attention to detail and accuracy, with a commitment to maintaining high standards of documentation integrity
• Strong organizational and time management skills to prioritize tasks and meet deadlines

Responsibilities

• Conduct comprehensive audits of clinical documentation and medical coding to ensure compliance with coding guidelines, regulations, and industry standards
• Analyze clinical documentation to identify discrepancies, coding errors, and documentation gaps that may impact coding accuracy, reimbursement, and compliance
• Collaborate with CDI department and healthcare providers to clarify documentation queries, improve documentation quality, and enhance coding specificity
• Provide education and training to physicians, clinicians, and coding staff on proper documentation practices, coding guidelines, and regulatory requirements
• Prepare detailed audit reports that include findings, recommendations, and action plans
• Present audit results to management, coding teams, and other necessary parties highlighting areas of concern and opportunities for improvement
• Communicate coding updates, regulatory changes, and compliance requirements to coding staff and healthcare providers
• Perform other related responsibilities as assigned

Preferred Qualifications

• A degree in health information management (HIM), medical coding, or a related field is preferred
• Prior experience in clinical documentation improvement (CDI) is highly desirable; familiarity with CDI processes, documentation integrity, and clinical documentation improvement programs is preferred

Benefits

• Competitive Compensation
• Attractive base salary with performance-based bonuses and rewards
• 401(k) plan with a generous company match, fully vested from day one
• Comprehensive Health and Wellness Benefits
• Flexible health, dental, and vision insurance options tailored to your needs
• Company contribution towards health savings accounts (HSA) for high-deductible health plan (HDHP) participants
• 100% company-paid short-term disability, long-term disability, and life insurance
• Wellness programs and resources to support your physical and mental health
• Generous paid time off, including vacation, sick leave, and 11 paid holidays annually
• Two paid volunteer days to support causes you're passionate about
• Flexible work arrangements to accommodate your lifestyle
• Robust onboarding program and ongoing training opportunities
• Reimbursement for role-related continuing education and certifications
• Paid parental leave for new parents
• Dependent care flexible spending accounts
• Support for work-life integration
• Work alongside professionals who share your commitment to Honest's high-quality, value-based care model
• Opportunities to contribute to meaningful projects and initiatives
• Team member recognition programs
• Team-building events and social activities