Clinical Documentation Integrity & Claims Auditor

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. Be capable of working independently, prioritizing competing responsibilities, and managing multiple assignments in a fast-paced environment. Prior CPT coding experience is a plus. Demonstrate a commitment to continuous learning and staying current with changes to coding guidelines, regulatory requirements, and healthcare documentation practices. Benefits 100% remote opportunity within the United States. Base salary range of $58,000–$90,000 per year , with the actual offer based on qualifications, experience, skills, education, certifications, and location. Employer-sponsored health, dental, and vision insurance , with low- or no-premium options. Generous paid time off . $100 monthly mobile or internet stipend . Stock options for all eligible employees. Bonus eligibility for roles below Director level. Parental leave program . 401(k) program . Additional benefits and total rewards for full-time employees. Opportunity to work at the intersection of healthcare quality, clinical documentation, coding, risk adjustment, and AI-enabled audit processes.