Clinical Auditor, Specialty Programs

Overview:

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares 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, quality-based healthcare to the home of patients who have difficult accessing care.

Our Shared Vision – Every patient deserves access to quality healthcare.

Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

Why You Should Want to Work with Us

• 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
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!

More details about the benefits we offer can be found at .

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 quality gaps. This role supports organizational goals for accurate risk scoring, improved quality performance, and adherence to regulatory and payer requirements.

Essential Duties and 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

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 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 Knowledge, Skills and Experience

• Bachelor’s degree in nursing

Posted Max Pay Rate: USD $100,000.00/Yr. Posted Min Pay Rate: USD $85,000.00/Yr. Pay Transparency: Individual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations. Notice:

HarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.