CDI Audit & Quality Improvement Specialist

Datavant; San Juan (PR); On-site; USD 50,000 - 58,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401k with match

PTO

Floating holidays

Flexible work arrangement

Career growth

Job summary

Datavant is seeking a Clinical Documentation Quality Improvement (CDQI) Audit Specialist to evaluate CDI reviews, ensure accuracy and compliance, and identify opportunities for education and process improvement. Your work will support revenue integrity and patient care.

The role is full-time and involves audits, feedback, onboarding, and education for CDQI staff, with collaboration across physicians and regulators to improve documentation and coding accuracy.

Qualifications

• 5+ years of CDI experience and/or auditing.
• 3+ years of clinical experience in an academic medical center.
• RN or BSN with CCDS or CDIP certification
• Must pass CDI skills competency assessment
• Experience with various EMRs and CDI software including Epic, Cerner, 3M, Iodine, etc.
• Strong organizational, teamwork and communication skills.

Responsibilities

• Conduct retrospective and concurrent audits of CDIQ Specialists work to ensure accurate documentation review practices, compliant query generation, assess appropriate capture of: SOI, ROM, CC/MCC, HCC, and align with coding, quality and regulatory requirements.
• Review missed opportunities impacting reimbursement, quality reporting and patient outcomes. Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients.
• Evaluate CDQI staff adherence to organizational workflows, policies and industry standards.
• Maintain audit tools, scoring methodologies, and audit documentation
• Provide individualized feedback to CDQI Specialists and develop education plans based on audit findings.
• Participate in onboarding and mentoring new CDQI staff.
• Deliver educational presentations on documentation, coding, regulatory updates and best practices.
• Collaborate with Physician Advisor regarding documentation opportunities and trends.
• Monitor program performance indicators, including query rates, query response rates, agreement rates, accuracy scores, case mix index impact and CC/MCC capture rates.
• Maintain confidentiality and safeguard protected health information (PHI), medical records, audit documentation, and company data in compliance with HIPAA, organizational policies, and regulatory requirements.
• Meet or exceed established production, quality, and performance metrics by completing assigned audits within designated timeframes and maintaining high standards of accuracy, consistency, and objectivity. Produce clear, actionable audit findings and educational feedback that support CDI staff development and program improvement

Skills

CDI auditing

Clinical experience

RN/BSN CCDS/CDIP

Regulatory knowledge

Communication

Education

RN or BSN with CCDS or CDIP

Tools

Epic

Cerner

3M CDI

Iodine

Job description

Datavant is seeking a Clinical Documentation Quality Improvement (CDQI) Audit Specialist to evaluate CDI reviews, ensure accuracy and compliance, and identify opportunities for education and process improvement. Your work will support revenue integrity and patient care.

The role is full-time and involves audits, feedback, onboarding, and education for CDQI staff, with collaboration across physicians and regulators to improve documentation and coding accuracy.