APP Clinical Documentation Integrity Reviewer

Job Summary

The APP Clinical Documentation Integrity (CDI) Reviewer establishes and supports a clinically focused documentation audit and education function within Documentation/Risk Adjustment. Leveraging advanced practice provider clinical judgment, this role evaluates whether medical records contain sufficient clinical evidence to support reported diagnoses, identifies documentation and compliance risks, and delivers peer-level education to improve documentation accuracy, specificity, and defensibility.

The reviewer partners with providers, coding, compliance, clinical leadership, and risk adjustment teams to strengthen audit readiness, reduce repeat findings, and address documentation issues proactively.

Essential Duties and Responsibilities

• Conduct targeted, risk-based clinical documentation audits of high-risk diagnoses, hierarchical condition categories (HCCs), and other areas of regulatory or organizational focus.

• Evaluate whether documented history, assessment, examination findings, diagnostic results, treatment, monitoring, and plan of care sufficiently support reported diagnoses.

• Identify unsupported, conflicting, nonspecific, or incomplete documentation and distinguish clinical validation concerns from coding accuracy issues.

• Analyze audit findings and documentation trends to identify recurring risks, root causes, and opportunities for process improvement.

• Develop and deliver focused, peer-level provider education and feedback to promote accurate, complete, and compliant documentation practices.

• Escalate complex, ambiguous, or high-risk cases to clinical leadership, compliance, or other appropriate stakeholders for review and resolution.

• Collaborate with coding and documentation teams to support compliant query practices, clarify clinical issues, and reduce avoidable rework and provider burden.

• Maintain accurate audit records, track findings and education outcomes, and prepare reports communicating risk themes, progress, and recommended actions.

• Stay current on relevant CMS guidance, ICD-10-CM conventions, Medicare Advantage risk adjustment requirements, clinical documentation standards, and organizational policies.

• Protect the confidentiality and security of patient information and perform all duties in accordance with applicable laws, regulations, and company policies.

Required Qualifications

Education
Master’s degree from an accredited advanced practice nursing or physician assistant program.

Experience
Minimum of three years of clinical practice experience as an advanced practice provider. Experience with clinical documentation integrity, risk adjustment, auditing, or provider education is strongly preferred. Experience reviewing complex adult or geriatric medical records is preferred.

Skills
Strong clinical assessment and critical-thinking skills; ability to evaluate documentation against the patient’s clinical picture; knowledge of compliant diagnosis documentation and risk adjustment principles; clear written and verbal communication; effective provider education and feedback skills; sound judgment when escalating risk; attention to detail; ability to analyze trends and manage multiple priorities independently in a remote environment; and proficiency with electronic health records and standard Microsoft Office applications.

Certifications/Licenses
Current, unrestricted license as a Nurse Practitioner, Physician Assistant, or other approved advanced practice provider in at least one U.S. state. National board certification appropriate to the APP discipline is required. Clinical documentation integrity, coding, audit, or risk adjustment certification is preferred.

Physical and Mental Requirements

• Ability to stand or sit for extended periods.

• Visual acuity and fine motor skills.

• Ability to travel locally or nationally as needed.

Work Environment

This position is performed in a remote, professional work environment and requires routine use of a computer, telephone, video conferencing, and electronic health record or audit systems.

Remote: Travel may be required up to 15% locally or nationally for meetings, education, or other business needs.

Sponsorship Statement

WellBe does not offer employment-based visa sponsorship for this position. Applicants must be legally authorized to work in the United States without the need for employer sponsorship now or in the future.

Pay Transparency Statement

Compensation for this position will be disclosed in accordance with applicable state and local pay transparency laws.

Safety-Sensitive Statement

This position has been designated as safety-sensitive. As such, the employee must be able to perform job duties in a manner that ensures the safety of themselves, coworkers, patients, and the public. The role requires full cognitive and physical functioning at all times.

Employees in safety-sensitive positions are subject to drug and alcohol testing, including for substances that may impair judgment or motor function, in accordance with applicable federal and state laws and company policy. Due to the safety-sensitive nature of this role and in alignment with federal law and workplace safety standards, the use of marijuana—including medical or recreational use—is prohibited. WellBe Senior Medical will comply with applicable state laws regarding medical marijuana and reasonable accommodations, where such laws do not conflict with safety requirements or federal regulations.

Drug Screening Requirement

As a condition of employment, WellBe Senior Medical requires all candidates to successfully complete a pre-employment drug screening. Ongoing employment may also be contingent upon compliance with the company’s Drug-Free Workplace Policy, which includes random, post-accident, and reasonable suspicion drug testing. The company reserves the right to test for substances that may impair an employee’s ability to safely and effectively perform their job duties.

Background Check Statement

Employment is contingent upon successful completion of a background check, as permitted by law. As a healthcare organization, WellBe conducts monthly FACIS (Fraud and Abuse Control Information System) checks on all employees. Continued employment is contingent upon satisfactory results of these checks, in accordance with applicable laws and regulations.

Equal Employment Opportunity (EEO) Statement

WellBe is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected status.

Americans with Disabilities Act (ADA)

WellBe Senior Medical is committed to complying with the Americans with Disabilities Act (ADA) and applicable state and local laws. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the job.

If you require an accommodation during the application, interview, or employment process, please contact Human Resources at HRPeopleLine@wellbe.com.

At-Will Employment Statement

Employment with WellBe is at-will unless otherwise specified by contract. This job description does not constitute an employment contract.

Disclaimer

This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.