Auditor/Educator In/Outpatient

Job Description

Essential Job Functions: Initial Audit and Education:

For assigned coding staff, conduct initial quality audits as they go through onboarding process for new project / client assignment, and provide education to staff based on initial quality audit findings. Review medical records for accuracy of coding and data quality. Elements included in reviews may include:

• CDI audit reviews
• Auditing: Reviewing medical records, including clinical notes, lab results, and other diagnostic information, to ensure documentation accurately reflects diagnoses, severity of illness, and risk of mortality.
• Compliance: Ensuring documentation complies with regulatory requirements, coding guidelines, and payer rules.
• Identifying Gaps: Identifying missed documentation opportunities, inconsistencies, and areas where documentation can be more specific or clarified.
• Query Review: Evaluating the appropriateness of queries issued to physicians, ensuring they are supported by clinical evidence and aligned with coding guidelines.
• Data Analysis: Analyzing data related to CDI performance, identifying trends, and reporting findings to leadership.
• Education and Training: Providing education and training to CDI staff, physicians, and other healthcare professionals on documentation best practices, coding guidelines, and regulatory requirements.

Skills and Qualifications:

• Clinical Knowledge: Strong understanding of disease processes, clinical conditions, and medical terminology.
• Coding Knowledge: Familiarity with ICD-10-CM/PCS, CPT, and other relevant coding systems.
• CDI Experience: Experience in clinical documentation integrity, including chart review and query writing.
• Analytical Skills: Ability to analyze data, identify trends, and make recommendations for improvement.
• Communication Skills: Excellent written and verbal communication skills to effectively communicate with various healthcare professionals.

Inpatient /Observation Cases

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
• Discharge disposition assigned
• Assigned Present on Admission (POA) indicators
• APR-DRG, MS-DRG, SOI, and ROM assignment for inpatient cases
• Appropriateness of queries created

Outpatient Cases (ER, SDS, Ancillary)

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
• All CPT assigned codes
• Modifier use and assignment
• APC assignment

Qualifications for Internal Candidates

Employee must be fluent in auditing facility inpatient, Outpatient is a plus. Will be trained in DRG appeal writing. Must be experienced in Word and Excel. CDI credential is a plus.

Qualifications

Must have CDI (Clinical Documentation integrity); CDIP(AHIIMA), CCDS (ACDIS) or CDEI (AAPC)

Job Info

• Job Identification 18175
• Regular or Temporary Regular
• Region Field Employees - Hourly X4E
• Full-Time/Part-Time Full-Time
• Client Expected Start Date 03/02/2026
• Required Years of Experience 5
• Resource Role Minimum Salary 38.5
• Resource Role Maximum Salary 56.5