Job Title: Clinical Documentation & Quality Auditor
Job Summary
The Clinical Documentation & Quality Auditor supports revenue integrity and regulatory compliance by reviewing provider documentation, identifying coding and documentation risks, and delivering structured, actionable feedback. The role focuses on pre-acquisition documentation audits, targeted denial analysis, and provider reporting to improve documentation quality, ensure compliant billing, and reduce revenue leakage. This position partners closely with RCM leadership, coding, and operational teams to identify trends and drive continuous improvement.
Key Responsibilities
Pre-Acquisition Documentation Audits
- Conduct structured reviews of provider documentation prior to practice acquisitions.
- Evaluate documentation against coding compliance standards, LCD/NCD policies, and payer requirements.
- Identify documentation deficiencies affecting coding accuracy and reimbursement.
- Prepare written audit reports with clear findings, risk summaries, and recommendations.
- Develop provider-specific education and remediation guidance.
Documentation Quality Monitoring
- Perform periodic internal documentation audits to ensure ongoing compliance.
- Identify trends related to:
- E/M level selection
- Incomplete or insufficient documentation
- Modifier misuse
- Medical necessity support
Denial Analysis & Provider Education Support
- Perform targeted reviews of coding- and documentation-related denials.
- Assist leadership in identifying documentation education needs based on denial trends.
- Develop concise, provider-friendly feedback reports.
- Coordinate findings with RCM leadership, vendors, and operational teams.
- Support documentation improvement initiatives, including review of clinical templates.
Qualifications & Skills
- Experience:
- 35 years of professional coding or auditing experience (preferred: 5+ years).
- Proven experience conducting documentation audits and providing provider feedback.
- Technical & Healthcare Knowledge:
- Strong knowledge of E/M guidelines, medical necessity standards, and LCD/NCD policies.
- Excellent analytical, written, and reporting skills.
- Proficiency in Microsoft Office or similar tools for reporting, templating, and one-page provider resources.
