CDI Specialist - QA
CDI Specialist - QA
Posted on :
10-07-2025
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
10-07-2025
Job Description
The CDI Specialist -QA (CDI-S QA) will serve as a quality assurance leader by auditing the work of Clinical Documentation Integrity Specialists (CDIS) and Clinical Documentation Integrity Coders (CDI-Cs) ensuring complete accurate and compliant diagnostic documentation and coding in alignment with ICD-10-CM guidelines CMS risk adjustment methodology payer requirements and Aledades internal standards. This role plays a critical part in maintaining the integrity of documentation review workflows and improving the effectiveness of field-level education. The CDI-S QA will provide structured feedback to CDI staff identify trends and training needs support quality improvement initiatives and collaborate with clinical coding and operational leaders. Occasional travel to practices may be required with most work performed remotely. The ideal candidate is detail-oriented quality-focused and fluent inor willing to masterGoogle Suite tools.
Primary Duties:
- Conduct routine and focused audits of CDIS and CDI-C chart reviews to assess accuracy compliance completeness and consistency. Identify documentation improvement opportunities and recommend corrections. Summarize audit findings and provide actionable feedback to CDI team members and leadership.
- Analyze trends across audit results to identify team- or market-level gaps. Collaborate with CDI leadership to design and refine quality standards protocols workflows and internal guidance materials. Contribute to continuous quality improvement initiatives.
- Support and deliver internal training and calibration sessions for the CDI team. Assist in onboarding new team members by validating their documentation and coding reviews. Serve as a subject matter expert on CMS HCC risk adjustment and documentation integrity best practices.
Minimum Qualifications:
- Bachelors degree in a healthcare-related field or equivalent experience required
- Current certification as a Certified Professional Coder (CPC) or equivalent
- CDEO (AAPC) CRC (AAPC) or CCDS-O (ACDIS) certification required
- Minimum of 3 years recent experience in Clinical Documentation Integrity or 5 years of risk adjustment auditing experience
- Deep understanding of ICD-10-CM coding HCC risk adjustment documentation compliance and value-based care principles
- Strong written and verbal communication skills with experience delivering feedback to peers or staff.
- Demonstrated ability to identify documentation gaps and explain the clinical and financial impacts of inaccurate coding
- Experience with EHR systems chart abstraction and outpatient clinical workflows
- Skilled in synthesizing audit results to drive education and process improvement
Preferred Key Skills and Abilities:
- Prior experience in a CDI QA audit or compliance oversight role
- Successful track record in outpatient coding and billing through previous experience
- Self-directed and solution oriented
- Strong understanding of value-based care principles particularly as they relate to the impact of clinical documentation and coding on risk adjustment payment models in value-based contracts
- Strong understanding of outpatient coding and billing
- Solution-oriented individual who can execute tactical continuous quality improvement work to deliver results in value-based contracts
- Excellent communicator who can articulate the impact of documentation and diagnosis initiatives to Aledade ACO member practices and their key staff (e.g. office managers practice billers etc.) and internally within the company.
- Ability to work collaboratively across Aledade clinical and non-clinical teams to gain buy-in and implement key documentation improvement initiatives
- References demonstrating high degree of integrity and professional accountability
Required Experience:
Unclear Seniority
Employment Type
Full-Time
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