Clinical Documentation Integrity, Claims Auditor

🔥 16 hours ago

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Perform audits based on organizational priorities, including concurrent CDI workflows and retrospective auditing. • Conduct reviews that may lead to the addition, deletion, adjustment, or confirmation of diagnoses. • Initiate queries for documentation clarification to ensure the highest level of clinical accuracy. • Utilize and review AI tools and 'Human-in-the-Loop' outputs to support modern auditing processes. • Assist in creating and communicating provider and vendor education regarding trends and opportunities in compliant coding practices. • Collaborate with the CDI Manager to make recommendations that enhance coding quality goals and outcomes. • Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and CMS Risk Adjustment guidance.

🎯 Requirements

• Clinical/Coding Background: 3+ years in outpatient CDI or 5+ years in risk adjustment coding/auditing. • Certifications: CPC or CRC (AAPC) or CDIP/CCDSR or CCS (AHIMA). • Tech Savvy: Experience with AI Tools, Copilots, and Google Suite. • Bonus Points: Prior CPT coding experience is a plus.

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles • Parental leave program • 401K program • And more....