Clinical Quality Auditor

About the role

The Clinical Quality Auditor performs comprehensive audits within Elara Caring’s skilled home health, hospice, and behavioral health agencies to ensure compliance with Medicare and Medicaid regulations. The auditor focuses on quality outcomes through areas such as ICD‑10 coding, Outcome and Assessment Information Set (OASIS), Value Based Purchasing (VBP), Care Compare, and clinical documentation. This role reports to the Manager of Quality Assurance and supports the mission of delivering high‑quality care to more than 60,000 patients daily in their homes.

Responsibilities

• Conduct comprehensive audits of home health, hospice, and behavioral health agencies for Medicare and Medicaid compliance.
• Review and verify accuracy of ICD‑10 coding.
• Audit Outcome and Assessment Information Set (OASIS) documentation.
• Evaluate Value Based Purchasing (VBP) metrics.
• Assess Care Compare data for quality performance.
• Examine clinical documentation to ensure quality outcomes.

Requirements

• Associate degree in Nursing (required).
• Three years of experience as a Registered Nurse in home health and/or hospice.
• Current state license as a Registered Nurse.
• Certified Homecare Coding Specialist (HCS‑D or HCS‑H) or willingness to obtain certification within 6 months.
• Certified OASIS Specialist‑Clinical (COS‑C) or willingness to obtain certification within 6 months, as applicable.
• Certified HOPE Specialist‑Clinical (CHS‑C) or willingness to obtain certification within 6 months, as applicable.
• Strong written and verbal communication skills.
• Proven organizational development and project management abilities.
• Working knowledge of regulations and reimbursement in home health, hospice, and behavioral health.
• Ability to maintain confidentiality of sensitive financial, clinical, and operational information.

Benefits

• Collaborative work environment.
• Competitive compensation package.
• Tuition reimbursement for full‑time staff.
• Continuing education opportunities at no cost to employees.
• Opportunities for advancement.
• Comprehensive medical, dental, and vision insurance plans.
• 401(k) plan with employer match.
• Paid time off, paid holidays, and family and pet bereavement leave.
• Pet insurance.