CDQI Audit Specialist

Accountabilities: Conduct retrospective and concurrent audits of CDQI specialist work to assess documentation review practices, compliant query generation, and appropriate capture of SOI, ROM, CC/MCC, and HCC.

Evaluate documentation practices against coding, quality, regulatory, organizational, and industry requirements.

Identify missed documentation opportunities that may affect reimbursement, quality reporting, clinical severity, and patient outcomes.

Collaborate with physicians, caregivers, and Physician Advisors to address documentation opportunities, trends, and clinical accuracy.

Evaluate adherence to established workflows, policies, procedures, and industry standards.

Maintain audit tools, scoring methodologies, documentation, and supporting records with a high degree of accuracy and consistency.

Provide individualized feedback to CDQI specialists and develop targeted education plans based on audit findings.

Participate in onboarding, mentoring, and development activities for new CDQI staff.

Deliver educational presentations covering clinical documentation, coding, regulatory updates, and CDI best practices.

Monitor key program performance indicators, including query rates, response rates, agreement rates, accuracy scores, case mix index impact, and CC/MCC capture rates.

Safeguard protected health information, medical records, audit documentation, and other sensitive data in accordance with HIPAA, privacy, security, and information governance requirements.

Complete assigned audits within established timeframes while meeting or exceeding production, quality, accuracy, consistency, and objectivity standards.

Produce clear and actionable audit findings and educational feedback that support staff development and continuous program improvement.

Requirements:

5+ years of experience in clinical documentation improvement and/or auditing.

3+ years of clinical experience in an academic medical center.

RN or BSN qualification with CCDS or CDIP certification.

Successful completion of a CDI skills competency assessment.

Experience working with multiple EMR and CDI platforms, such as Epic, Cerner, 3M, Iodine, or similar systems.

Strong understanding of clinical documentation, coding, regulatory requirements, and CDI practices.

Excellent organizational, communication, teamwork, and interpersonal skills.

Ability to work professionally, efficiently, objectively, and positively in a collaborative environment.

Strong attention to detail and ability to analyze audit findings and translate them into actionable feedback.

Ability to maintain confidentiality and handle protected health information responsibly.

Benefits:

Estimated total cash compensation range of $50–$57.50 USD per hour.

Comprehensive medical, dental, and vision insurance for full-time employees.

401(k) savings plan with employer match.

Paid time off, floating holidays, and paid holidays.

Flexible work arrangements.

Opportunities for career growth and professional development.

Full-time employment.

Employment sponsorship is not available for this role.

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