Auditor

• Conduct audits and testing procedures of assigned areas and Plan delegates, including detailed testing activities, documenting findings in audit work papers, developing detailed document requests lists, conducting walk-throughs, and proposing recommendations for improvement.
• Develop and maintain audit tools based on regulatory compliance with DHCS, DMHC, and CMS requirements.
• Document audit conclusions that are based on a complete understanding of the process, circumstances, and risk.
• Perform validation audits to determine if actions have been taken to mitigate risks identified.
• Support the development and acceptance of corrective action plans (CAPs) from internal departments and delegates to ensure accuracy and regulatory adherence.
• Validate corrective action plans (CAPs) from internal departments and delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
• Perform evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues.
• Support the identification of and communicates issues raised, offering recommended solutions relevant to business and risk.
• Conduct regulatory research and provides interpretation of regulations to ensure appropriate application.
• Support the maintenance of risks for assigned areas in the Compliance Risk Universe to ensure risk mitigations plans are developed and risks assessed and refreshed as needed.
• Support the development of risk assessments to identify compliance risks posed to the Plan.
• Conduct routine monitoring activities to ensure compliance with regulatory and contractual requirements.
• Assist with reports for presentation to the Executive Compliance Committee and the IEHP Governing Board.
• Conduct compliance assessments as needed.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Compliance Auditor II

• Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy, CPT, HCPCS, and ICD-10 coding compliance, Modifier usage, Workers’ compensation billing rules and state-specific fee schedules, Claim submission accuracy and clean claim rates, Payment posting and adjustment accuracy, AR follow-up effectiveness and denial resolution workflows
• Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance
• Denial & Revenue leakage analysis: Analyze denial trends across WC, Medicare, and commercial payers, Identify root causes of denials and recommend corrective actions, Quantify revenue impact from: Coding errors, Missed charges, Underpayments, Inefficient workflows
• Ensure adherence to: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, State Workers’ Compensation regulations, Documentation standards for pain management procedures
• Support internal and external audit readiness (RAC, MAC, payer audits).
• Reporting & KPI development through audit dashboard Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements
• Partner with all BHC teams to develop and deliver targeted education based on audit findings.
• Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency
• Establish and maintain quality assurance programs across RCM functions
• Perform routine QA reviews of staff productivity and accuracy
• Recommend automation opportunities and system enhancements
• Assumes other responsibilities as appropriate to the position and organizational needs

RCM Auditor

• Coordinates the review and audit of completed SBA and business banking loan packages post-closing in compliance with policies and procedures, regulatory guidelines, and investor standards by gathering and reviewing necessary documents and information within designated time frames.
• Communicates with internal staff, customers/clients, lenders, SBA partners, counsel, and other stakeholders to respond to inquiries, resolve post-close exceptions, and obtain additional documentation needed to complete the file.
• Ensures compliance with internal policies, SBA SOP requirements, regulatory and investor requirements, and quality control standards.
• Reviews files for completeness, accuracy, and adherence to SBA eligibility, documentation, and closing requirements.
• Identifies documentation deficiencies, collateral exceptions, or compliance gaps and works to resolve or escalate issues as appropriate.
• May support post-close audit reporting, file certification, and reconciliation activities, including reviewing final loan terms, fees, and disbursements for accuracy.

SBA Post Close Auditor

• Conduct independent appraisals of quality and compliance systems within technically advanced manufacturing settings
• Performs complex and demanding domestic and international (subject to experience) audits of suppliers of raw materials, packaging components, drug substance or other process intermediates, and finished drug products, or contracted services
• Audits are conducted in accordance with cGMP´s, ISO Standards, IPEC, ICH Q7A and company procedures
• Plans, coordinates and conducts scheduled or unscheduled cGMP audits of complex internal AstraZeneca Operational departments to ensure compliance to CGMP´s and AstraZeneca standards
• Provide clear and scientifically/technically justified interpretations and support for any audit findings and proposed corrective and preventive actions
• Liaise directly with local AZ and/or regional and global senior management, where necessary, to ensure issues are understood and proposed actions are acceptable
• Interpret and apply cGMP regulations and expectations
• Develop and interpret audits findings across the scope of the Global Quality Audit (GQA) in order to communicate trends and provide recommendations to address such developing trends in a proactive manner

Senior Auditor, Cell Therapy Quality

• Coordinates the review and audit of completed SBA and business banking loan packages post-closing in compliance with policies and procedures, regulatory guidelines, and investor standards by gathering and reviewing necessary documents and information within designated time frames
• Communicates with internal staff, customers/clients, lenders, SBA partners, counsel, and other stakeholders to respond to inquiries, resolve post-close exceptions, and obtain additional documentation needed to complete the file
• Ensures compliance with internal policies, SBA SOP requirements, regulatory and investor requirements, and quality control standards
• Reviews files for completeness, accuracy, and adherence to SBA eligibility, documentation, and closing requirements
• Identifies documentation deficiencies, collateral exceptions, or compliance gaps and works to resolve or escalate issues as appropriate
• May support post-close audit reporting, file certification, and reconciliation activities, including reviewing final loan terms, fees, and disbursements for accuracy

Post Close Auditor

• Responsible for performing quarterly audit engagements
• Conduct audits across operational, financial, regulatory, and/or technology areas
• Prepare clear and well-organized audit work papers documenting findings

Senior Auditor, Financial Operations

• Conduct audits to evaluate compliance with a wide variety of Federal and State laws, regulatory rules & regulations, PSJH policies and procedures.
• Collaborate with Case Management, Utilization Review, Revenue Integrity, Clinical Risk, Internal Legal Affairs and Finance under supervision.
• Navigate and analyze data across Clinical EMR and Epic Billing systems, reviewing line-item charges and supporting documentation.
• Present audit findings collaboratively to reduce risk within Providence as a system.

Compliance Auditor

• Undertake underwriting, transactional, and claims audits in accordance with client scope requirements
• Liaise with Audit Administrator regarding audit preparations, preparedness of Coverholder/TPA, etc
• Review PAQ (Pre-Audit Questionnaire) responses and associated documentation, where appropriate draft follow-up questions (inquiries) that should be undertaken during on-site review and looping in senior team members (as necessary)
• Coordinate delivery of project (audit) including liaising with clients to report any concerns or progress updates
• Undertaking pre audit, onsite, and post audit activities while communicating work plans to team members
• Allocating responsibility for scope parts; maintaining oversight of on-site work; chairing wrap-up meetings
• Write or supervise production of reports and appendices; if required (or if significant issues identified) prepare initial summary assessment of findings for client
• Communicate effectively with the various stakeholders in the project including team members
• Ensure weekly timesheet is completed accurately to enable effective monitoring of the audit's profitability
• Work with the peer reviewer to ensure high quality work product prior to releasing audit to client

Lloyd's/Delegated Auditor

• Travelling to domestic, international, major program, and/or subsidiary company locations to perform audits of Northrop Grumman programs with other Internal Audit teammates.
• Performing audit procedures to review program related business functions such as: Program planning, scheduling, and control, in both fully compliant and tailored Earned Value Management (EVM) implementations.
• Substantiation of financial EAC update, reporting and recording with substantiation and reserves assessment, when required.
• Supplier management, including supplier performance reporting and management and contract requirements flowdown.
• Risk and Opportunity Management process and incorporation into Financial EACs.
• Management reporting of program data both internally and externally.
• Ensuring proper recording of transactions and compliance with applicable company policies/procedures, related contracts/agreements, and applicable laws.

Principal Auditor

• Management and coordination of multiple external project audits
• Processing complex information from various sources
• Evaluate, review and analyze data using objective criteria
• Collaborate with internal and external audit firms
• Identify and report risks to project stakeholders

Operations Auditor

• Review medical records across an array of outpatient specialties to ensure that the correct diagnosis and procedure codes were assigned
• Review physician documentation and performing audits to determine accuracy
• Prepare audit results reports as requested by the engineering and client success teams
• Provide coding insights, education, and examples to Fathom engineering and client success teams to accelerate product development
• Track, aggregate and summarize the changing coding and billing rules for the engineering and client success teams

Medical Coding Auditor

• Independently lead complex, agile technology and business audits with objectivity
• Manage the creation and execution of audit programs, including drafting testing plans and acceptance criteria, performing walkthroughs, identifying controls, and executing testing procedures for complex processes
• Apply critical thinking data analytics, and AI-assisted audit techniques to evaluate evidence, identify root causes, assess risk levels, and recommend control enhancements or process improvements
• Leverage tools such as Python, SQL, or visualization platforms to perform full-population testing, anomaly detection, and pattern analysis
• Communicate effectively with audit clients through sprint reviews and audit reports
• Build and maintain strong, trust-based relationships with IT and business leaders
• Provide coaching and feedback to audit team members

Lead AI & Technology Risk Auditor

• delivering BSI’s audit services to assigned clients in accordance with all BSI, scheme and regulatory requirements to assure timely, cost-effective service delivery that assures satisfaction of our customer needs
• conduct various types of audits
• Prepare assessment reports and deliver findings to clients to ensure client understanding of the assessment decision and clear direction to particular items of corrective action where appropriate
• Recommend the issue, re-issue or withdrawal of certificates, and report recommendations in accordance with BSI policy, procedures and prescribed timeframe
• Maintain overall account responsibility and portfolio accountability for nominated accounts to ensure an effective partnership, whilst ensuring excellent service delivery and account growth
• Lead assessment teams as required, ensuring that team members are adequately briefed to maintain quality of service and that effective working relationships are sustained both with Clients and within the team
• Responsible for contacting clients and scheduling the visits, planning the assessments, making travel plans, conducting the assessments, reporting and managing the results
• Responsible for attending any required training and following all procedures, processes, policies within BSI for management of clients, management of a home-based office, use of BSI equipment and communication both internal and external to the organization
• Responsible for monitoring the client accounts to ensure that records, visit cycle, invoicing and other related matters are properly dealt with to assure client satisfaction is maintained
• Responsible for leading teams, when necessary, and mentoring and coaching new or inexperienced colleagues as needed to meet the business needs.

Aerospace Management Systems Auditor

• Assist in identifying, analyzing, and assessing risk throughout Mercury and contribute to the development of the annual audit plan
• Scope and plan multiple audits across Mercury products and operations
• Conduct process walkthroughs and execute audit testing to confirm the design and operational effectiveness of internal controls
• Assess compliance with Mercury’s compliance obligations
• Socialize, document, and report audit issues identified
• Collaborate with teams to develop appropriate action plans, track audit issue remediation, and conduct issue follow up testing
• Other duties as assigned

Senior Internal Auditor

• Provides a critical role in meeting the Internal Audit mission by delivering independent, objective assurance and advisory services designed to add value and improve Sharp HealthCare's governance, risk management, and control processes.
• Responsible for executing audit engagements end-to-end, including planning, fieldwork, and timely reporting.

Internal Auditor II

• Accurately audits hospital Inpatient, Ambulatory Surgery, Observation, and any other outpatient encounter visit for appropriate reimbursement.
• Serves as a clinical coding subject matter expert and analyze and evaluate documentation issues with consultation from the medical and clinical staff.
• Audits ICD-10 diagnostic codes and CPT-4 procedure codes for outpatient, ambulatory surgery, and observation visits.
• Serves in an advisory and educator role for Coding Specialists.
• Reports coding quality accuracy rate for each coder and monitors productivity rate for each coder.

Coding Compliance Auditor

• Review inpatient medical records and claims to ensure accurate coding and reimbursement
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes
• Audit coding quality and identify opportunities for improvement
• Investigate and resolve provider disputes with a fair, fact-based approach
• Analyze complex clinical documentation and coding scenarios
• Collaborate with other teams to clarify coding and medical information
• Contribute to cost savings by improving payment accuracy and reducing errors

Inpatient Medical Coding Auditor

• Actively lead and participate in regularly occurring Operational Safety audits throughout the Disney Experiences segment throughout the various stages of the audit (e.g., scope development, audit activity, post-audit follow up, etc.)
• Leverage data driven information, documented procedure and in-field observations to verify safety critical operating practices align with both Disney and External safety standard.
• Develop expertise in attractions, transportation, entertainment, recreation and other operations focused lines of businesses to effectively understand operating practices to audit against.
• Build relationships with leaders at all levels to gain their trust and assure the audit findings, observations, and understandings developed are accurate to the operations in review.
• Drive stakeholder agreement on any items from the audit processes to help develop actionable plans for mitigation.
• Create and present Management and Executive audit report-outs that include driving follow-up requirements to completion.
• Act as a regular representative for operations related initiatives through reoccurring meetings with partners throughout the segment.
• Steer technical conversations with Senior Leadership with a confident/fact-based approach to drive actionable conclusions to identified issues.
• Proactively drive both short-term and long-term scope planning, using subject matter expertise to make decisions to influence audit decisions for all audit activity for the team.
• Champion one or multiple operations lines of businesses supported by WSA, by working directly with WSA Leadership and Operations leadership to serve as a resource for answers and decision making as events occur.
• Use auditing expertise to diagnose the root cause behind any systemic issue found, both in regular auditing and through other investigation work.
• Act as a mentor to team members and clients by daily actions, direction provided, and thoughtfulness when making critical decisions.

Senior Safety Auditor

• Lead and perform moderate to high-complexity audit work with limited supervision
• Identify key risks across end-to-end processes and develop risk-based audit scopes and test plans
• Execute and document audit procedures in accordance with Institute of Internal Auditors (IIA) standards
• Provide guidance and mentorship to audit team members throughout audit execution, fostering collaboration and professional growth
• Partner with business leaders to validate findings, identify root causes, and agree on practical, sustainable corrective actions—while maintaining professional independence
• Monitor management’s progress on remediation efforts and validate completed actions
• Support department-wide projects and initiatives to enhance LCIA’s audit methodologies, tools, and assurance capabilities
• Own and advance the Bank's established Compliance and Financial Crimes Compliance coverage strategies, refining them over time to ensure complete regulatory coverage with risk-proportionate auditing.
• Stay current on emerging audit standards, regulatory changes, and industry trends, and share insights with the broader team
• Leverage artificial intelligence throughout the audit lifecycle, including annual planning, risk assessment, audit planning, fieldwork, and reporting, to enhance efficiency, consistency, and insight generation
• Work cross-functionally to advance the Bank's compliance monitoring capabilities toward real-time, continuous compliance auditing through the application of data analytics, AI, and LLMs

Lead Compliance Auditor

• Responsible for providing patient focused, standardized, compliant revenue cycle support that will assist Providence St Joseph Health in meeting financial objectives.

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