The CDI Specialist – QA (CDI-S QA) acts as a quality assurance leader by reviewing the work of Clinical Documentation Integrity Specialists (CDIS) and Clinical Documentation Integrity Coders (CDI-Cs). This role ensures that diagnostic documentation and coding are accurate, complete, and compliant with ICD-10-CM guidelines, CMS risk adjustment methodologies, payer requirements, and Aledade’s internal policies. The position is essential for upholding the integrity of documentation workflows and enhancing the effectiveness of educational efforts in the field. The CDI-S QA provides structured feedback, identifies trends and training needs, supports quality improvement efforts, and collaborates with clinical, coding, and operational teams. While most work is remote, occasional travel to practices may be necessary. The ideal candidate is detail-oriented, quality-driven, and proficient in—or willing to learn—Google Suite tools.

Primary Responsibilities:

– Perform regular and targeted audits of CDIS and CDI-C chart reviews to evaluate accuracy, compliance, completeness, and consistency. Identify opportunities for documentation improvement and suggest corrections. Summarize findings and provide actionable feedback to CDI staff and leadership.
– Analyze audit trends to uncover team or market-level gaps. Work with CDI leadership to develop and refine quality standards, workflows, protocols, and internal guidance. Contribute to ongoing quality improvement efforts.
– Support and lead internal training and calibration sessions for the CDI team. Assist with onboarding new team members by reviewing their documentation and coding work. Act as a subject matter expert on CMS HCC risk adjustment and best practices for documentation integrity.

Minimum Requirements:

– Bachelor’s degree in a healthcare-related field or equivalent experience
– Certified Professional Coder (CPC) or equivalent certification
– Certification in CDEO (AAPC), CRC (AAPC), or CCDS-O (ACDIS)
– At least 3 years of recent experience in Clinical Documentation Integrity or 5+ years in risk adjustment auditing
– Strong knowledge of ICD-10-CM coding, HCC risk adjustment, documentation compliance, and value-based care
– Excellent written and verbal communication skills, with experience providing feedback to peers or staff
– Proven ability to identify documentation gaps and explain the clinical and financial implications of incorrect coding
– Experience with EHR systems, chart abstraction, and outpatient clinical workflows
– Ability to translate audit findings into educational and process improvement strategies

Preferred Skills and Qualifications:

– Previous experience in a CDI QA, audit, or compliance role
– Proven success in outpatient coding and billing
– Self-motivated and solution-focused
– Strong understanding of how clinical documentation and coding affect risk adjustment in value-based care contracts
– In-depth knowledge of outpatient coding and billing
– Ability to implement tactical quality improvement initiatives that support value-based care outcomes
– Strong communication skills to explain documentation and diagnosis initiatives to Aledade ACO practices and internal teams
– Collaborative mindset with the ability to work across clinical and non-clinical teams to implement documentation improvements
– References that reflect high integrity and professional accountability