CDI Reconciliation Auditor

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August 19

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CorroHealth

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Healthcare Insurance • SaaS • Artificial Intelligence

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

📋 Description

• Conduct reconciliations of CDI and coding outcomes to ensure alignment with final DRG assignments. • Review discrepancies between CDI specialists and coders, resolving variances to support accurate claim submission. • Perform quality audits on Physician Audit reviews to validate the appropriateness of coding and documentation. • Ensure clinical documentation meets regulatory standards, payer guidelines, and organizational policies. • Identify trends and patterns in documentation and coding errors, providing feedback and education to CDI and coding teams. • Collaborate with internal teams to develop and implement process improvements based on audit findings. • Provide education and training to CDI and coding staff on reconciliation outcomes and audit findings. • Serve as a liaison between CDI specialists, coders, and physicians to resolve documentation and coding queries. • Maintain up-to-date knowledge of coding guidelines (ICD-10, CPT, etc.), payer policies, and regulatory requirements. • Prepare and present regular reports on reconciliation and audit outcomes, including key metrics and recommendations.

🎯 Requirements

• Bachelor’s degree in Nursing, Health Information Management, or a related field; or equivalent clinical experience. • 3-5 years of experience in CDI, coding, or clinical auditing roles. • Strong background in DRG validation and Physician Audit processes. • Experience with healthcare coding systems and standards (ICD-10, CPT, HCPCS). • Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Practitioner (CDIP) preferred. • Certified Coding Specialist (CCS) or equivalent coding certification required. • Strong analytical and problem-solving skills. • Proficient in coding software and EHR systems. • Excellent written and verbal communication abilities. • Detail-oriented with a focus on accuracy and compliance.