Prospective Chart Review Quality Auditor

You will be responsible for performing audits of pre-visit medical record reviews to identify chronic conditions reported in prior years and conditions lacking supporting documentation. You will evaluate suggestions or clinical alerts presented by Prospective Chart reviewers to ensure they meet specificity requirements supporting clinical indicators and comply with Risk Adjustment documentation standards. Additionally, you will conduct reviews, provide feedback to professionals such as Clinical Chart Reviewers and third-party vendors, and respond to questions submitted by Prospective Chart reviewers. It will be your duty to document detailed audit findings, including errors and missed opportunities in the Prospective chart reviews. You will need to correlate activities, processes, and HCC results/metrics to evaluate outcomes, as well as assist in developing workflows, curriculum, and policies and procedures related to the Pre-visit Medical Record review team. Your role will also involve understanding, adhering to, and implementing the Company's policies and procedures. Providing excellent customer service skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients, will be essential. You are expected to take personal responsibility for personal growth by acquiring new skills, knowledge, and information, engaging in excellent communication, setting and completing challenging goals, and demonstrating attention to detail and accuracy in your work product. The minimum experience required for this position is 2+ years of clinical experience and 5+ years of chart review and medical coding/auditing experience. An advanced level of clinical knowledge associated with chronic disease states is also necessary. You must hold a Medical doctor or Nurse qualification and a Coding Certification through AHIMA or AAPC. CPC or CPMA certification is preferred. To excel in this role, you should possess the ability to be a team player, exercise initiative in responding to provider requests and concerns, and have excellent interpersonal and telephone communication skills. General understanding of the health care industry, particularly the provider relations field, is desired. Attention to detail, accurate data entry, ability to work under pressure with minimal supervision, multitasking, completing projects in a timely fashion, and meeting deadlines are crucial. Strong analytical, problem-solving, and organizational skills are a must. Additionally, you should have strong written and verbal communication skills to work with multiple internal and external clients. Proficiency in Microsoft Office applications is required. This position is located in India_Bangalore.,