Clinical Performance Auditor – CDI
Job Description:
• Plans, designs, develops and performs quality assessments on data elements and structures to document and evaluate integrity, completeness, quality, and appropriateness of formats, records and structures
• Configures, operates and develops manual and/or automated methods, processes and procedures to test output or input based on data compliance, quality and use requirements as established by product management, client specifications, and governance programs
• Performs regular and ad hoc reviews, audits, and investigations of data activity and integrity; prepares reports and summaries of findings
• Produces and updates guidelines and documentation of test development processes, procedures and standards
• Complete record reviews on client records to identify best practice process improvement opportunities
• Complete data analysis of reviews completed and create summary presentations for internal and external communication of record review results
• Engage with client utilization management teams and provide feedback regarding record review and education associated with identified opportunities for best practice improvement
• Develop and provide education regarding clinical concepts to clients and internal stakeholders and product designers
• Participate in product performance audits and communicate results with product team
• Perform medical record review to support product innovation and development
• Audit performance of key data science conditions and elements
Requirements:
• Bachelor’s Degree or equivalent in Nursing (RN)
• 5+ years of experience in utilization management and/or clinical documentation and auditing
• Self-starter, who is extremely motivated to demonstrate success
• Attention to detail, highly organized, with an absolute focus on quality of work
• Team player DNA with a desire to solve for the interests of our clients and of our business
Benefits:
• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• Generous paid time off for non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays
• Flexible time off for exempt team members + 13 paid holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups
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• Plans, designs, develops and performs quality assessments on data elements and structures to document and evaluate integrity, completeness, quality, and appropriateness of formats, records and structures
• Configures, operates and develops manual and/or automated methods, processes and procedures to test output or input based on data compliance, quality and use requirements as established by product management, client specifications, and governance programs
• Performs regular and ad hoc reviews, audits, and investigations of data activity and integrity; prepares reports and summaries of findings
• Produces and updates guidelines and documentation of test development processes, procedures and standards
• Complete record reviews on client records to identify best practice process improvement opportunities
• Complete data analysis of reviews completed and create summary presentations for internal and external communication of record review results
• Engage with client utilization management teams and provide feedback regarding record review and education associated with identified opportunities for best practice improvement
• Develop and provide education regarding clinical concepts to clients and internal stakeholders and product designers
• Participate in product performance audits and communicate results with product team
• Perform medical record review to support product innovation and development
• Audit performance of key data science conditions and elements
Requirements:
• Bachelor’s Degree or equivalent in Nursing (RN)
• 5+ years of experience in utilization management and/or clinical documentation and auditing
• Self-starter, who is extremely motivated to demonstrate success
• Attention to detail, highly organized, with an absolute focus on quality of work
• Team player DNA with a desire to solve for the interests of our clients and of our business
Benefits:
• Competitive total rewards (base salary + bonus, if applicable)
• Customizable benefits package (3 medical plans with Health Saving Account company match)
• Generous paid time off for non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays
• Flexible time off for exempt team members + 13 paid holidays
• Paid parental leave (including maternity + paternity leave)
• Education assistance opportunities and free LinkedIn Learning access
• Free mental health and family planning programs, including adoption assistance and fertility support
• 401(K) program with company match
• Pet insurance
• Employee resource groups
Apply tot his job
Apply To this Job