CDI Reconciliation Auditor

CorroHealth

22d

About The Position

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: The CDI Reconciliation Auditor is responsible for performing detailed quality reviews and reconciliations of clinical documentation and coding outcomes, with a focus on DRG (Diagnosis-Related Group) validation and Physician Audit reviews. This role ensures that documentation supports accurate coding and billing practices, in compliance with regulatory and payer requirements.

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 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.

Nice To Haves

Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Practitioner (CDIP) preferred.

Responsibilities

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.