What We're Looking For:

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.

This role is full-time.

What You Will Do:

• 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

What You Need to Succeed:

• 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.

What We Offer:

• Benefits for Full-Time employees include comprehensive health, dental, and vision insurance. 401k Savings plan with match.
• Paid time off (PTO) plan, plus floating holidays and paid holidays.
• Flexible work arrangements
• Opportunities for career growth and development

At Datavant our total rewards strategy powers a high-growth, high-performance, health technology company that rewards our employees for transforming health care through creating industry-defining data logistics products and services.

The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job.

The estimated total cash compensation range for this role is:

$50-$57.50 USD

To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.

This job is not eligible for employment sponsorship.