Offer summary

Qualifications:

Bachelor's degree in a healthcare-related field or equivalent experience., Current certification as a Certified Professional Coder (CPC) or equivalent., Certifications such as CDEO, CRC, or CCDS-O are required., At least 3 years of recent experience in Clinical Documentation Integrity or 5+ years in risk adjustment auditing..

Key responsibilities:

Conduct audits of clinical documentation and coding for accuracy and compliance.

Provide feedback and training to CDI staff to improve documentation quality.

Analyze audit results to identify trends and areas for improvement.

Collaborate with leadership to develop quality standards and support quality initiatives.

Job description

The CDI Specialist QA (CDIS QA) will serve as a quality assurance leader by auditing the work of Clinical Documentation Integrity Specialists (CDIS) and Clinical Documentation Integrity Coders (CDICs), ensuring complete, accurate, and compliant diagnostic documentation and coding in alignment with ICD10CM guidelines, CMS risk adjustment methodology, payer requirements, and Aledade’s internal standards. This role plays a critical part in maintaining the integrity of documentation review workflows and improving the effectiveness of fieldlevel education. The CDIS 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 detailoriented, qualityfocused, and fluent in—or willing to master—Google Suite tools.

Primary Duties:Conduct routine and focused audits of CDIS and CDIC 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 marketlevel 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:
Bachelor’s degree in a healthcarerelated field or equivalent experience required
Current certification as a Certified Professional Coder (CPC), or equivalent
CDEO (AAPC), CRC (AAPC), or CCDSO (ACDIS) certification required
Minimum of 3 years recent experience in Clinical Documentation Integrity or 5+ years of risk adjustment auditing experience
Deep understanding of ICD10CM coding, HCC risk adjustment, documentation compliance, and valuebased 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
Selfdirected and solution oriented
Strong understanding of valuebased care principles, particularly as they relate to the impact of clinical documentation and coding on risk adjustment payment models in valuebased contracts
Strong understanding of outpatient coding and billing
Solutionoriented individual who can execute tactical continuous quality improvement work to deliver results in valuebased 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 nonclinical teams to gain buyin and implement key documentation improvement initiatives
References demonstrating high degree of integrity and professional accountability