Clinical Documentation Integrity & Claims Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Documentation Integrity & Claims Auditor based in the United States. This is a fully remote opportunity supporting clinical documentation integrity, coding accuracy, and claims quality within a healthcare environment. The role plays an important part in quality and risk-adjustment initiatives by ensuring diagnostic information is complete, accurate, and appropriately supported by medical records. You will conduct concurrent and retrospective chart audits while validating ICD-10-CM coding and identifying opportunities for clarification or correction. The position combines clinical expertise, coding knowledge, analytical review, and emerging AI-supported auditing tools. You will collaborate with clinical documentation, provider, coding, and operational teams to improve compliant coding practices and claims outcomes. The role also provides opportunities to contribute to provider education, process improvement, and the continued development of modern audit workflows. The ideal candidate is analytical, detail-oriented, comfortable working independently, and committed to maintaining current knowledge of coding and risk-adjustment standards. Accountabilities - Perform medical record audits based on organizational priorities, including concurrent Clinical Documentation Integrity (CDI) workflows and retrospective auditing. - Review clinical documentation and validate diagnostic information and ICD-10-CM coding for accuracy, completeness, and compliance. - Identify diagnoses that should be added, deleted, adjusted, or confirmed based on supporting medical documentation. - Initiate appropriate provider queries when additional clarification is needed to establish the highest level of accurate and compliant clinical documentation. - Review and utilize AI-assisted auditing tools and Human-in-the-Loop outputs as part of evolving clinical documentation and claims review processes.

- Support the identification of coding trends, documentation gaps, and improvement opportunities. - Assist with developing and communicating provider and vendor education related to compliant coding practices and recurring documentation trends. - Partner with the Clinical Documentation Improvement Manager to recommend process improvements that strengthen coding quality and operational outcomes. - Help ensure claims are accurate, complete, and aligned with ICD-10-CM guidelines, internal protocols, and applicable CMS guidance. - Maintain current knowledge of ICD-10-CM coding guidelines, AHA Coding Clinic guidance, and CMS risk-adjustment requirements. - Contribute to continuous improvement initiatives involving audit methodology, documentation quality, coding processes, and technology-enabled workflows. Requirements - Hold one of the following professional certifications: CPC or CRC through AAPC; CDIP or CCDS-R; or CCS through AHIMA . - Have at least 3 years of outpatient Clinical Documentation Integrity experience or 5 years of risk-adjustment coding and auditing experience . - Demonstrate strong knowledge of clinical documentation, medical record review, ICD-10-CM coding, and coding validation practices. - Understand CMS risk-adjustment guidance and applicable coding compliance requirements. - Be comfortable working with AI tools, Copilots, and technology-supported auditing workflows. - Have experience with Google Workspace or similar productivity and collaboration tools. - Demonstrate strong analytical and problem-solving abilities with exceptional attention to detail. - Possess excellent written and verbal communication skills, particularly when explaining coding and documentation findings to providers and other stakeholders.