Clinical Documentation Auditor (Part Time)

The Clinical Documentation Auditor plays a crucial role by ensuring the quality and integrity of members medical records. The auditor will be required to monitor, measuring, and report on the quality of documentation created by healthcare professionals. This role will ensure documentation is thorough, accurate and ensures compliance with required Model of Care documentation requirements. The auditor will randomly review health records for content and context and provide feedback that may have the potential to impact patient care or impact outcomes.This role provides summarized feedback to the Clinical Operations team on documentation audit findings. Key Responsibilities: • Strong understanding of medical terminology, disease process and Provider Partners Model of Care documentation requirements • Strong knowledge of HIPPA regulations and other healthcare regulatory bodies • Knowledgeable in all areas of documentation requirements • Knowledge of ICD-10 coding and HCC documentation • Audits a quantity of charts for each provider determined by Clinical Leadership • Assists in developing tools to summarize findings and report to providers direct reports • Develops tools and process to maintain records and track audit completion • Attends required meetings and participates in adhoc committees as needed • Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan policies • Excellent written and oral communication skills • Experience and ability to use bolthires Office productsQualifications: • Education- Registered Nurse.Bachelor’s degree Preferred • Previous experience with Medicare Advantage Special Needs Plan (SNP) • Previous experience in a healthcare setting, preferably in an administrative or coordination role • Strong computer skills, including proficiency with electronic health record (EHR) systems and bolthires Office applications • Excellent communication and interpersonal skills, with the ability to interact effectively with members, healthcare professionals, and administrative staff • Detail-oriented with strong organizational and time management skills • Knowledge of medical terminology, billing processes, and healthcare regulations preferred • Ability to work independently and collaboratively in a team environment, prioritizing tasks and managing workload effectively Apply tot his job Apply tot his job