Clinical Auditor, Specialty Programs

Job reputed company: • Conduct comprehensive audits of clinical documentation to ensure accurate Hierarchical Condition Category (HCC) capture, risk adjustment compliance, and closure of reputed company gaps. • 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. Requirements: • 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 arenaflex 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 Benefits: • 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 Apply tot his job