- Corewell Health (Grand Rapids, MI)
- …2 years of relevant experience: + Legal or regulatory field; health care focus desirable + Compliance auditor , nurse auditor , or other audit function + ... but can fluctuate based on meetings, site visits, or compliance needs. Job Summary Assists with management of ...compliance needs. Job Summary Assists with management of compliance program standards and work plans for designated financial… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... timely manner. + Prepares trend and other reports for compliance audits and charge processes. + Serves as a...CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid… more
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare ... **UPMC Corporate Compliance ** is seeking a dedicated and detail-oriented **Intermediate Compliance Auditor ** to join our team! This position will be based… more
- Northwell Health (Glen Cove, NY)
- …Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations ... the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to… more
- Northwell Health (Westbury, NY)
- …reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. + Applies coding rules and ... the validation review process. + Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. + Instructs professional staff in code… more
- Trinity Health (Livonia, MI)
- …of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures ... and utilization management. + Customer service background is required. **Preferred:** + Registered Nurse + Bachelor's degree + Two plus (2+) years of charge audit,… more
- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire Hours: 40 ... Start Date: December 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities for a state… more
- AdventHealth (Orlando, FL)
- …you'll contribute:** The Surgical and Procedural Services Safety and Regulatory Compliance Auditor evaluates the surgical and procedural environment, policies, ... and procedures to ensure compliance with all regulatory standards and regulations. Responsible for...Florida or multi state license as a Licensed Practical Nurse **or** + RN current valid State of Florida… more
- UNC Health Care (Chapel Hill, NC)
- …the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as ... all patients. Educates on proper creation of provider compliant queries. 8. Ensures compliance with third party and State and Federal regulations. 9. Audits CDS… more
- US Tech Solutions (Newark, NJ)
- …months contract with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state ... Conduct on-site reviews at provider offices to assess record quality and compliance with documentation standards. + Prepare reports summarizing findings and provide… more
- AdventHealth (Orlando, FL)
- …role you'll contribute:** The Clinical Documentation Integrity Manager is a Registered Nurse and/or a Registered Health Information Administrator with a high level ... team:** + Reviews concurrent and retrospective medical record for documentation compliance including completeness and accuracy for severity of illness (SOI), risk… more
- Centene Corporation (Jefferson City, MO)
- …staff at the health plan in the use of audit process and tools + Facilitate compliance with the auditing process + Act as a consultant related to system auditing to ... RESIDE IN MISSOURI **Ideal candidate will be a Licensed Practical Nurse (LPN) with auditing experience.** **Education/Experience:** Bachelor's degree in related… more
- Molina Healthcare (Syracuse, NY)
- …functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide ... behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and… more
- University of Southern California (Los Angeles, CA)
- …to evaluate department charge processes to improve charge capture and coding compliance . The Senior RI Specialist also coordinates with Keck Medical Center of ... USC Administration, IS, Compliance , Clinical Informatics and Integration personnel on technology projects...and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center… more
- St. Luke's University Health Network (Allentown, PA)
- …coding determination made by the government or commercial payors, or their auditor representative. + Facilitate clinical chart reviews to assist with supporting ... + Participate in Administrative Law Judge (ALJ) hearings and/or formal meetings with auditor or payor representatives in defense of coding appeals, as needed. +… more
- Trinity Health (Livonia, MI)
- …to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge ... coding credentials _and/or Licensed Vocational Nurse / Licensed Practical Nurse licensure_ is required. CHC (Healthcare Compliance Certification) preferred.… more
- Trinity Health (Livonia, MI)
- …to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge ... other coding credentials _and/or Licensed Vocational Nurse / Licensed Practical Nurse licensure_ is required. CHC (Healthcare Compliance Certification) _CHRI_… more
- GE Vernova (Greenville, SC)
- …and qualification phase to final inspections in order to verify product compliance with technical and quality requirements. Supplier Quality Engineer will be working ... process audits, special process audits and product inspections to verify compliance to GE specifications & technical regulations/standards with timely audit report… more
- HCA Healthcare (San Antonio, TX)
- …true discrepancy and complete incident reports as required. You will review RX Auditor report and generate investigation reports for nurse managers/directors to ... hospital personnel politely and appropriately. You will perform and monitor compliance for quality control and performance improvement functions as assigned. You… more