Position Summary: The Clinical Documentation and Coding Integrity Quality Auditor performs clinical documentation validation reviews. Performs quantitative and qualitative reviews and analysis of the clinical health records and physician queries both concurrently and retrospectively to ensure documentation is accurate, consistent and complete. Quality Auditor identifies educational opportunities, including discrepancies in clinical indicators and diagnostic statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization. Quality Auditor is also involved in the clinical denial/appeal process for DRG challenges and clinical validations of both external and internal claims. The Quality Auditor utilizes analysis of data, dashboards, and audits to assist in identifying gaps, root causes and solutions for clinical documentation specialists and physician leadership. The Quality Auditor acts as a subject matter expert and resource for the Clinical Documentation Specialists and assumes the role of CDS as demands for services requires. May perform other duties as assigned. Job Qualifications (Required): LICENSURE: Medical Graduate, Nurse Practitioner or Physician Assistant EDUCATION: Master#s degree CERTIFICATION: Clinical Documentation Improvement Certification (CCDS or CDIP) and ability to obtain Certified Coding Specialist (CCS) Certification within 1 year of hire. EXPERIENCE: Minimum of 1 year CDS experience; Leadership skills and demonstrated expertise in clinical documentation improvement/coding. Skilled educator and communicator. Excellent interpersonal and team building skills, with an ability to collaborate effectively with physicians, nurses and members of the health care team. Proficient/functional knowledge of electronic medical record systems and information technology. Willingness to learn CDI software is required. Willingness to maintain flexible work hours, assume other duties as assigned, and provide weekend/holiday coverage as needed. Preferred Qualifications: 3+ years of CDS experience. # At PVHMC, your safety is our priority. Our working environments comply with current state mandates and CDC recommendations.##As a Hospital that focuses on ending the COVID-19 pandemic, we have a responsibility to ensure the safety of our staff and communities. Subject to applicable law, we#require that all employees show proof of full vaccination and#booster (if eligible) against COVID-19 before their start date.
Position Summary:
The Clinical Documentation and Coding Integrity Quality Auditor performs clinical documentation validation
reviews. Performs quantitative and qualitative reviews and analysis of the clinical health records and physician
queries both concurrently and retrospectively to ensure documentation is accurate, consistent and complete.
Quality Auditor identifies educational opportunities, including discrepancies in clinical indicators and diagnostic
statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization. Quality
Auditor is also involved in the clinical denial/appeal process for DRG challenges and clinical validations of both
external and internal claims. The Quality Auditor utilizes analysis of data, dashboards, and audits to assist in
identifying gaps, root causes and solutions for clinical documentation specialists and physician leadership. The
Quality Auditor acts as a subject matter expert and resource for the Clinical Documentation Specialists and
assumes the role of CDS as demands for services requires. May perform other duties as assigned.
Job Qualifications (Required):
LICENSURE: Medical Graduate, Nurse Practitioner or Physician Assistant
EDUCATION: Master’s degree
CERTIFICATION: Clinical Documentation Improvement Certification (CCDS or CDIP) and ability to obtain
Certified Coding Specialist (CCS) Certification within 1 year of hire.
EXPERIENCE: Minimum of 1 year CDS experience; Leadership skills and demonstrated expertise in clinical
documentation improvement/coding. Skilled educator and communicator. Excellent interpersonal and team
building skills, with an ability to collaborate effectively with physicians, nurses and members of the health care
team. Proficient/functional knowledge of electronic medical record systems and information technology.
Willingness to learn CDI software is required. Willingness to maintain flexible work hours, assume other duties
as assigned, and provide weekend/holiday coverage as needed.
Preferred Qualifications: 3+ years of CDS experience.
At PVHMC, your safety is our priority. Our working environments comply with current state mandates and CDC recommendations. As a Hospital that focuses on ending the COVID-19 pandemic, we have a responsibility to ensure the safety of our staff and communities. Subject to applicable law, we require that all employees show proof of full vaccination and booster (if eligible) against COVID-19 before their start date.

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