APP Clinical Documentation Integrity Reviewer

Wellbe Senior Medical • Chicago, IL

19d • Remote

About The Position

The APP Clinical Documentation Integrity (CDI) Reviewer establishes and supports a clinically focused documentation audit and education function within Documentation/Risk Adjustment. Using advanced practice provider clinical judgment, the reviewer evaluates whether medical records contain sufficient clinical evidence to support reported diagnoses, identifies documentation and compliance risks, and provides peer-level education to improve documentation accuracy, specificity, and defensibility. The role partners with providers, coding, compliance, clinical leadership, and risk adjustment teams to strengthen audit readiness, reduce repeat findings, and proactively address documentation issues.

This remote role involves auditing high-risk diagnoses and HCCs, evaluating clinical support for reported diagnoses, identifying documentation issues, analyzing trends, educating providers, escalating complex cases, and maintaining audit records and reports. It requires keeping current with applicable CMS guidance, ICD-10-CM conventions, Medicare Advantage risk adjustment requirements, documentation standards, and organizational policies. The position is safety-sensitive, and employment is subject to drug screening and background checks, including ongoing checks as described in the posting. WellBe does not provide employment-based visa sponsorship.

Requirements

• Master’s degree from an accredited advanced practice nursing or physician assistant program.
• At least three years of clinical practice experience as an advanced practice provider.
• Current, unrestricted license as a Nurse Practitioner, Physician Assistant, or other approved advanced practice provider in at least one U.S. state.
• National board certification appropriate to the APP discipline.
• Strong clinical assessment and critical-thinking skills, including the ability to evaluate documentation against the patient’s clinical picture.
• Knowledge of compliant diagnosis documentation and risk adjustment principles.
• Clear written and verbal communication skills and effective provider education and feedback skills.
• Sound judgment when escalating risk, attention to detail, and ability to analyze trends and manage multiple priorities independently in a remote environment.
• Proficiency with electronic health records and standard Microsoft Office applications.
• Ability to stand or sit for extended periods; visual acuity and fine motor skills; ability to travel locally or nationally as needed.
• Legally authorized to work in the United States without employer sponsorship now or in the future.
• Successful completion of a pre-employment drug screening; ongoing employment may be contingent on compliance with the company Drug-Free Workplace Policy and testing requirements.
• Successful completion of a background check; continued employment is contingent on satisfactory monthly FACIS checks.

Nice To Haves

• Experience with clinical documentation integrity, risk adjustment, auditing, or provider education.
• Experience reviewing complex adult or geriatric medical records.
• Clinical documentation integrity, coding, audit, or risk adjustment certification.

Responsibilities

• Conduct targeted, risk-based clinical documentation audits of high-risk diagnoses, HCCs, and other regulatory or organizational focus areas.
• Evaluate whether history, assessment, examination findings, diagnostic results, treatment, monitoring, and care plans sufficiently support reported diagnoses.
• Identify unsupported, conflicting, nonspecific, or incomplete documentation and distinguish clinical validation concerns from coding accuracy issues.
• Analyze audit findings and documentation trends to identify recurring risks, root causes, and process improvement opportunities.
• Develop and deliver focused, peer-level provider education and feedback to promote accurate, complete, and compliant documentation.
• Escalate complex, ambiguous, or high-risk cases to clinical leadership, compliance, or other appropriate stakeholders.
• Collaborate with coding and documentation teams to support compliant query practices, clarify clinical issues, and reduce avoidable rework and provider burden.
• Maintain accurate audit records, track findings and education outcomes, and prepare reports on risk themes, progress, and recommended actions.
• Stay current on relevant CMS guidance, ICD-10-CM conventions, Medicare Advantage risk adjustment requirements, clinical documentation standards, and organizational policies.
• Protect patient information and perform duties in accordance with applicable laws, regulations, and company policies.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level