- Optum (San Juan, PR)
- …of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or ... and accuracy. Standards are defined by the department Provide clear and concise clinical logic to the providers when necessary Examine, assess, and document business… more
- Zenith (Sarasota, FL)
- …leadership. This position can be filled in ANY Zenith Branch Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on ... state fee schedules, coding guidelines, healthcare regulations and medical compliance . Monitors billing for trends. Communicates with providers regarding disputed… more
- Syneos Health Careers (Morrisville, NC)
- Description Quality and Compliance Assessor - Clinical Monitoring Excellence (Remote, 75% Travel, East & West Coast Roles) Syneos Health(R) is a leading fully ... a place where everyone feels like they belong. Job Responsibilities Quality and Compliance Assessor - Clinical Monitoring Excellence (Remote, 75% Travel, East &… more
- Ochsner LSU Health System (Shreveport, LA)
- …both targeted and ad hoc charge capture audits. Works in conjunction with clinical personnel during all audits and schedules, prepares action plans, and reports out ... Audit Committee. Assists, advises, and provides expert consultation with the clinical departments to ensure all charges and medical documentation are appropriate… more
- Catalent, Inc. (Kansas City, MO)
- …home to our Oral & Specialty Drug Delivery, Biologics Analytical Services and Clinical Supply Services businesses. The site provides a range of integrated services ... solid dosage forms, from formulation development and analytical testing to clinical and commercial-scale manufacture. The Kansas City facility is a… more
- SKLD (Bloomfield Hills, MI)
- …*Participate in QAPI processes in centers that relate to accurate coding, clinical reimbursement, and compliance . Assure that established infection control and ... MDS coding, Care Area, or Reimbursement concern and address appropriately with the Clinical team. *Conduct Quality of life meetings to establish OBRA schedule. Team… more
- Astrix Technology (Los Angeles, CA)
- ** Clinical Compliance Auditor ** Clinical Los Angeles, CA, US Pay Rate Low: 100000 | Pay Rate High: 150000 + Added - 04/04/2025 Apply for Job We're ... in the biotechnology industry, and they're on the lookout for a talented ** Clinical Compliance Auditor ** to join their dynamic team! If you're passionate… more
- Centene Corporation (Salem, OR)
- …in a clinical field or equivalent experience. 4+ years of combined clinical and compliance or auditing experience in a healthcare environment. Familiarity ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Elara Caring (Fort Worth, TX)
- …to eligibility, billing, coding, and clinical documentation. Duties of the Billing Compliance Auditor include but are not limited to: (1) conducting audits ... Time, in the Right Place. **Job Description:** **REMOTE POSITION** The Billing Compliance Auditor performs comprehensive audits within the Skilled Home Health,… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Health Care Compliance (CHC) - Compliance Certification Board; Certified Clinical Documentation Specialist (CCDS) - ... for the position, and employer business practices. **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp… more
- Elevance Health (Grand Prairie, TX)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1:** This role requires associates to be in-office **1-2** days per ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying issues… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based on position type and/or level **Job Summary** In this job, as a Clinical Auditor RN, you'll perform charge capture accuracy audits by reviewing and ... and executing audit tasks in clinical departments/functions. + Evaluate clinical documentation for compliance , meeting all regulations stipulated by federal… more
- PeaceHealth (Vancouver, WA)
- **Description** PeaceHealth is seeking an Internal Auditor Senior - Organizational Integrity. This remote role requires the incumbent to work & reside in OR, WA or ... AK by date of hire. Our Internal Auditor Sr is an independent, objective assurance and consulting activity designed to add value and improve an organization's… more
- UNC Health Care (Chapel Hill, NC)
- …from entity to entity across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during ... we serve. Summary: This positon trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that are owned or… more
- Trinity Health (Albany, NY)
- …required. Must have 5 or more years' experience as a risk adjustment auditor and educator and/or clinical documentation improvement specialist with a solid ... expertise to direct and fulfill efforts toward the improvement and integrity of clinical documentation through the role of auditor and educator to support… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship and leadership programs + And more! **Description** The Professional Coding Compliance Auditor develops and executes audit, monitoring, and education ... development and delivering educational and training programs for professional billing and clinical compliance based on the latest Federal and State regulations… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Reporting to the Director, Compliance Audit and Analysis, the Sr. Compliance Auditor will develop and execute audit, monitoring, and education for ... and professional billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluate facility/professional billing … more
- Trinity Health (Syracuse, NY)
- …required. Must have 5 or more years' experience as a risk adjustment auditor and educator and/or clinical documentation improvement specialist with a solid ... if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding and documentation in… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- Billing Auditor for Shared Services Fully Remote * Rochester, Buffalo, or Syracuse, NY * Revenue Cycle Description Billing Auditor for Shared ServicesBuffalo, ... of PPCWNY's mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for… more
- Veterans Affairs, Veterans Health Administration (Murfreesboro, TN)
- …in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality of clinical , financial, and administrative ... is located in the Health Information Management (HIM) section in the Clinical Operations/Health Informatics Service at the Tennessee Valley Healthcare System (TVHS).… more
