Clinical Auditor, Specialty Programs

Job Description: 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: Associates 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 Apply To this Job Company : HarmonyCares Salary : Work from home .