Sr. Clinical Audit & Education Associate

About Salud Healthcare & the Role

Salud Healthcare is a tech-forward services organization that helps private practices and provider groups succeed in value-based and alternative payment models. The Sr. Clinical Audit & Education Associate sits at the intersection of coding accuracy, compliance, and provider enablement — safeguarding the integrity of Salud's risk adjustment programs while raising the documentation and coding proficiency of the physicians and coders we support.

Position Summary

Reporting to the Sr. Manager, HCC Audit, Compliance and Education, the Sr. Clinical Audit & Education Associate ensures the accuracy of medical coding data and clinical documentation across Salud's Medicare Advantage and managed care risk adjustment work. This role pairs hands-on chart review with active education: conducting both retrospective and prospective reviews to validate Hierarchical Condition Categories (HCCs), while simultaneously training physicians and medical coders on compliance guidelines. It is a hybrid role based at our headquarters in Miramar, FL, with three days per week on-site.

Job Responsibilities

Chart Review & HCC Validation

• Conduct retrospective and prospective chart reviews to validate HCC capture and confirm that every reported condition is clinically supported.

• Review EHR records against MEAT (Monitor, Evaluate, Assess, Treat) criteria to ensure documentation substantiates each diagnosis.

• Validate coding accuracy against ICD-10-CM guidelines and CMS-HCC model logic, reconciling suspect and unconfirmed conditions.

• Apply a strong working knowledge of the differences between the CMS-HCC V24 and V28 models, accounting for their impact when validating captures and advising on the transition.

Compliance & Risk Mitigation

• Detect coding discrepancies, unsupported diagnoses, and documentation gaps that create audit exposure, and act to prevent compliance penalties.

• Interpret internal metrics and documentation patterns to determine whether identified risks are being effectively mitigated.

• Ensure all reviews adhere to CMS, OIG, and internal compliance guidelines; escalate findings, trends, and areas of concern.

• Support RADV audit readiness and internal audit initiatives with well-documented, defensible review findings.

Provider & Coder Education

• Train physicians and medical coders on documentation and compliance guidelines, translating audit findings into practical, specialty-relevant guidance.

• Develop custom educational materials — tip sheets, presentations, and targeted job aids — built around the gaps identified in review.

• Deliver clear, engaging presentations to clinical and coding audiences that drive adoption of better documentation practices.

• Build feedback loops so education is grounded in real audit results and drives measurable improvement in documentation quality.

Qualifications Required

• 5+ years of experience in medical coding, including at least 2 years focused on Medicare Advantage (MA) and managed care risk adjustment models.

• Active CRC, CPC, or CPMA certification (AAPC or equivalent).

• Strong, demonstrable understanding of the differences between CMS-HCC V24 and V28 risk adjustment models.

• Working knowledge of ICD-10-CM, MEAT documentation standards, and CMS risk adjustment and RADV guidelines.

• Excellent presentation and communication skills, with a proven ability to educate and influence physicians and coders — a central requirement of this role.

• Proficiency with EHR systems and Microsoft Office, particularly Excel and PowerPoint.

Preferred

• Bilingual (English / Spanish) — highly preferred; the ability to educate and build trust with providers and coders in both languages is a strong plus.

• Additional AAPC or AHIMA credentials (e.g., CDEO, CIC, CCS).

• Prior experience delivering provider-facing education or coder-training programs.

• Familiarity with value-based care and MSO, ACO, or IPA environments.

• Experience with audit analytics and documentation-pattern reporting.

Why Salud. We hire against five values, and they describe how we actually work. Be Bold — challenge the status quo and act with urgency, even when the path is uncertain. Be Selfless — put patients, partners, and teammates first, and share the credit. Be Authentic — bring your whole self, and give honest, candid feedback. Be Accountable — own the outcome and answer for it. Deliver Results — measure what counts, and push until the numbers actually move.

Salud Healthcare provides equal employment opportunities to all employees and applicants for employment, and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex (including pregnancy, sexual orientation, and gender identity or expression), national origin, disability status, genetic information, citizenship status, protected veteran status, marital status, or any other characteristic protected by federal, state, or local law.