HarmonyCares · 3 weeks ago
Clinical Auditor, Specialty Programs
Troy, MI
Full-time
Onsite
Mid Level
$101K/yr - $112K/yr
3+ years expHarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. The Clinical Auditor, Specialty Programs is responsible for conducting comprehensive audits of clinical documentation to ensure accurate HCC capture and compliance, supporting organizational goals for improved quality performance.
Hospital & Health Care
Responsibilities
Perform 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 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
Qualification
Required
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
Preferred
Bachelor's degree in nursing
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
Company
HarmonyCares
Founded in 1993, HarmonyCares provides comprehensive medical care in the home, including in-home physician visits for older adults and individuals with complex health needs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Elissa Estopinal
VP, Chief of Staff to the CEO
Matthew Chance
Chief Executive Officer
Company data provided by crunchbase