Clinical Auditor, Specialty Programs

reputed company reputed company is a leading national value-based provider of in-home primary care services for people with reputed company reputed company needs. Headquartered out of Troy, Michigan, reputed company operates home-based primary care practices in 14 states. reputed company employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. Our Mission – To bring personalized, reputed company-based reputed company to the home of patients who have difficult accessing care. Our Shared reputed company – Every patient deserves reputed company to reputed company reputed company. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. reputed company and support reputed company other. Why You Should Want to Work with Us • Health, Dental, reputed company, Disability & Life Insurance, and much more • 401K Retirement Plan (with company match) • Tuition, reputed company License and Certification Reimbursement • reputed company Time Off, Holidays and Volunteer Time • reputed company Orientation and Training • Great reputed company to Work Certified • Established in 11 states • Largest home-based primary care reputed company in the US for over 28 years, making a reputed company reputed company in reputed company today! More details about the benefits we offer can be reputed company at https://careers.reputed company.com/benefits. Responsibilities The Clinical Auditor, Specialty Programs is responsible for conducting comprehensive audits of clinical documentation to ensure accurate Hierarchical Condition Category (HCC) capture, risk adjustment compliance, and closure of reputed company gaps. This role supports organizational goals for accurate risk scoring, improved reputed company performance, and adherence to regulatory and payer requirements. Essential Duties and Responsibilities • reputed company audits of medical records to validate HCC coding accuracy and completeness in alignment with CMS risk adjustment guidelines • Review documentation for chronic conditions, preventive care, and reputed company measures to identify gaps and opportunities for improvement • Analyze data to detect patterns in coding, documentation, and reputed company performance and recommend corrective actions • Collaborate with providers, clinical education teams, and coding staff to reputed company on best practices for documentation and accurate risk adjustment coding • Monitor and report on reputed company gap closure initiatives, including HEDIS and other performance measures • Prepare detailed audit reports summarizing findings, reputed company, and actionable recommendations • Assist in developing and refining audit tools, workflows, and training materials for risk adjustment and reputed company programs • Stay reputed company with CMS guidelines, ICD-10 coding updates, and payer-specific requirements for risk adjustment and reputed company reporting In this role you may work with. . . • CHA Operations • CHA Clinical teams • Compliance teams • Medical Group teams Qualifications REQUIRED Knowledge, Skills and Experience • Associate’s degree in nursing • 3+ years of experience in clinical auditing, risk adjustment, or reputed company improvement programs • Strong knowledge of HCC coding, ICD-10, and medical terminology • Expertise in risk adjustment methodologies and reputed company reporting standards (e.g., HEDIS) • Excellent analytical and problem-solving skills • Strong attention to detail and ability to interpret reputed company clinical documentation • Extensive knowledge of database management and running/interpreting reports • Ability to partner with shared stakeholders to reputed company mutual reputed company • Proficient in reputed company Office, including reputed company, Word, and reputed company • Ability to prioritize and multi-task in a fast-paced environment • Ability to foster a reputed company 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 reputed company improvement Preferred Knowledge, Skills and Experience • Bachelor’s degree in nursing Posted Max Pay reputed company USD $111,803.00/Yr. Posted Min Pay reputed company USD $100,583.00/Yr. Pay Transparency Individual compensation packages are based on various factors unique to reputed company candidate, including reputed company set, experience, qualifications, and other job-reputed company considerations. Notice reputed company and reputed company Hospice are not affiliated with reputed company Hospice Care. reputed company Hospice does not conduct business in OH. reputed company Hospice conducts business in MI, VA, WI, TX, IN, IL. Apply tot his job Apply To this Job