Clinical Documentation Integrity & Claims Auditor (AI)

TL;DR

Clinical Documentation Integrity & Claims Auditor (AI): Ensuring the accuracy of diagnostic information and claims compliance for a healthcare provider with an accent on ICD-10 CM coding and risk adjustment. Focus on performing medical record audits, utilizing AI-driven auditing tools, and educating providers to enhance clinical documentation quality.

Location: Must be based in the USA

Salary: $58,000 - $90,000 base salary annually

Company

hirify.global is a mission-driven healthcare company dedicated to improving the well-being of older Americans through integrated health insurance and clinical care.

What you will do

• Perform concurrent and retrospective medical record audits to ensure diagnostic accuracy.
• Conduct coding validation reviews to adjust or confirm diagnoses based on clinical documentation.
• Initiate provider queries to clarify documentation and ensure high clinical accuracy.
• Leverage AI tools and Human-in-the-Loop outputs to support and modernize auditing workflows.
• Create and deliver educational materials for providers regarding compliant coding practices.
• Collaborate with the CDI Manager to recommend process improvements for coding quality.

Requirements

• Must be based in the United States
• 3+ years of experience in outpatient CDI or 5+ years in risk adjustment coding/auditing.
• Active certification: CPC, CRC, CDIP, CCDSR, or CCS.
• Proficiency with AI tools, Copilots, and Google Suite.
• Strong analytical, problem-solving, and communication skills.
• Ability to work independently in a fast-paced startup environment.

Nice to have

• Prior CPT coding experience.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave program.
• Stock options for all employees.
• 401K program.
• $100 monthly mobile or internet stipend.
• Bonus eligibility for all roles.