CDQI Audit Specialist

As a Clinical Documentation Quality Improvement (CDQI) Audit Specialist, you will be instrumental in evaluating the quality, accuracy, compliance and effectiveness of CDI reviews while identifying opportunities for education, process improvement and revenue integrity enhancement.  The Auditor provides feedback, education and performance monitoring to support continuous improvement of the CDI program.  Join us in this critical role where your efforts will have a direct and meaningful impact on the quality and effectiveness of patient care.

• →Conduct retrospective and concurrent audits of CDIQ Specialists work to ensure accurate documentation review practices, compliant query generation, assess appropriate capture of: SOI, ROM, CC/MCC, HCC, and align with coding, quality and regulatory requirements.
• →Review missed opportunities impacting reimbursement, quality reporting and patient outcomes. Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients.
• →Evaluate CDQI staff adherence to organizational workflows, policies and industry standards.
• →Maintain audit tools, scoring methodologies, and audit documentation
• →Provide individualized feedback to CDQI Specialists and develop education plans based on audit findings.
• →Participate in onboarding and mentoring new CDQI staff.
• →Deliver educational presentations on documentation, coding, regulatory updates and best practices.
• →Collaborate with Physician Advisor regarding documentation opportunities and trends.
• →Monitor program performance indicators, including query rates, query response rates, agreement rates, accuracy scores, case mix index impact and CC/MCC capture rates.
• →Maintain confidentiality and safeguard protected health information (PHI), medical records, audit documentation, and company data in compliance with HIPAA, organizational policies, and regulatory requirements. Adhere to established privacy, security, and information governance standards when accessing, reviewing, storing, and communicating sensitive information.
• →Meet or exceed established production, quality, and performance metrics by completing assigned audits within designated timeframes and maintaining high standards of accuracy, consistency, and objectivity. Produce clear, actionable audit findings and educational feedback that support CDI staff development and program improvement

• 5+ years of CDI experience and/or auditing.
• 3+ years of clinical experience in an academic medical center.
• RN or BSN with CCDS or CDIP certification
• Must pass CDI skills competency assessment
• Experience with various EMRs and CDI software including Epic, Cerner, 3M, Iodine, etc.
• Ability to function in a professional, efficient, and positive manner
• Strong organizational, teamwork and communication skills.