Clinical Documentation Integrity & Claims Auditor

Devoted Health • Waltham, MA

3d • $58,000 - $90,000 • Remote

About The Position

The Clinical Documentation Integrity (CDI) & Claims Auditor will report to the manager, Clinical Documentation Improvement as part of the Practice Operations team. The CDI And Claims Auditor is a key part of Devoted’s Quality & Risk Adjustment strategy and claims cycle processes. This position ensures the accuracy of diagnostic information and coding (ICD-10 CM) by performing audits and medical chart reviews. Additionally, this role ensures that claims submitted on behalf of Devoted Medical are accurate, complete, and compliant with ICD-10 CM guidelines, internal protocols, and CMS guidance.

Requirements

• 3+ years in outpatient CDI or 5+ years in risk adjustment coding/auditing.
• CPC or CRC (AAPC) or CDIP/CCDSR or CCS (AHIMA).
• Experience with AI Tools, Copilots, and Google Suite.
• Strong analytical and problem-solving skills.
• Excellent oral and written communication skills for provider education.
• Ability to work independently and manage multiple tasks in a fast-paced startup environment.

Nice To Haves

• Prior CPT coding experience is a plus.

Responsibilities

• 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.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed