Clinical Auditor, Specialty Programs
HarmonyCares
full-time
Posted on:
Location Type: Remote
Location: Remote • Missouri • 🇺🇸 United States
Visit company websiteSalary
💰 $100,583 - $111,803 per year
Job Level
Mid-LevelSenior
About the role
- Conduct comprehensive audits of clinical documentation to ensure accurate Hierarchical Condition Category (HCC) capture, risk adjustment compliance, and closure of quality gaps.
- Validate HCC coding accuracy and completeness in alignment with CMS risk adjustment guidelines.
- Review documentation for chronic conditions, preventive care, and quality measures to identify gaps and opportunities for improvement.
- Analyze data to detect patterns in coding, documentation, and quality performance and recommend corrective actions.
- Collaborate with providers, clinical education teams, and coding staff to educate on best practices for documentation and accurate risk adjustment coding.
- Monitor and report on quality gap closure initiatives, including HEDIS and other performance measures.
- Prepare detailed audit reports summarizing findings, compliance risks, and actionable recommendations.
- Assist in developing and refining audit tools, workflows, and training materials for risk adjustment and quality programs.
- Stay current with CMS guidelines, ICD-10 coding updates, and payer-specific requirements for risk adjustment and quality reporting.
Requirements
- Associate’s degree in nursing
- 3+ years of experience in clinical auditing, risk adjustment, or quality improvement programs
- Strong knowledge of HCC coding, ICD-10, and medical terminology
- Expertise in risk adjustment methodologies and quality reporting standards (e.g., HEDIS)
- Excellent analytical and problem-solving skills
- Strong attention to detail and ability to interpret complex clinical documentation
- Extensive knowledge of database management and running/interpreting reports
- Ability to partner with shared stakeholders to achieve mutual success
- Proficient in Microsoft Office, including Outlook, Word, and Excel
- Ability to prioritize and multi-task in a fast-paced environment
- Ability to foster a collaborative work environment
- Interpersonal skills sufficient to effectively communicate both written and orally with department teams, practitioners, and team members
- Ability to work independently and manage multiple audits simultaneously
- Commitment to compliance, accuracy, and continuous improvement
Benefits
- Health, Dental, Vision, Disability & Life Insurance, and much more
- 401K Retirement Plan (with company match)
- Tuition, Professional License and Certification Reimbursement
- Paid Time Off, Holidays and Volunteer Time
- Paid Orientation and Training
- Great Place to Work Certified
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
HCC codingICD-10clinical auditingrisk adjustment methodologiesquality reporting standardsdata analysisdatabase managementreport interpretationquality measurespreventive care
Soft skills
analytical skillsproblem-solving skillsattention to detailcollaborationinterpersonal skillscommunication skillsindependencemulti-taskingprioritizationcommitment to continuous improvement
Certifications
Associate’s degree in nursing