Auditor

• Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable.
• Works with CDIS on DRG assignment and educates on missed Query opportunities.
• Reviews discharge summaries for coding accuracy.
• Appeals RAC DRG review charts.

Hospital Coding Auditor

• Perform retrospective quality audits (QA) of audit cases
• Validate that findings are supported, accurately documented, and consistent with audit rationale
• Ensure audit determinations appropriately apply payer policies, coding/billing guidelines, and reimbursement rules
• Confirm the audit file contains complete evidence to support recoveries/avoidance and to withstand provider appeals
• Apply established QA methodology to evaluate performance consistently
• Identify and classify errors
• Maintain quality dashboards and trending reports
• Participate in calibration sessions with reviewers
• Provide structured feedback to audit teams
• Support business reviews by summarizing quality findings, root causes, and improvement opportunities
• Recommend updates to job aids, templates, and audit checklists to reduce variation and improve defensibility
• Escalate high-risk issues to leadership

Quality Auditor, Hospital Bill Audits, Itemized Bill Review

• Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
• Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
• Assists with training of new associates.

Clinical Provider Auditor II – Payment Integrity

• The Senior Auditor plans and performs complex operational, financial, and information systems audits, internal control reviews, risk assessments, and advisory projects for USF in accordance with professional standards.
• Ensures appropriate controls exist, processes are efficient and accurate, and operating procedures are in compliance with laws, regulations, university policies, procedures, and best practices.
• Identifies value-added internal control and business process improvement opportunities designed to strengthen financial and IT-related general controls and to improve operational efficiency and effectiveness.
• Prepares reports of findings and makes recommendations to resolve conditions noted.
• Candidate must have proven experience executing projects and engaging business partners to enhance the control environment.
• This position has no overnight travel, minimal overtime, and offers flexible work hours.

Senior Auditor

• Conduct insurance premium audits for Workers Compensation, General Liability, and Automobile policies by auditing policyholder’s records, and applying manual rules and company standards.
• Prepare for the audit by identifying the necessary information and type of records needed.
• Prepare schedule to maximize optimal use of time.
• Correspond with insured via phone, email and mail to setup audit appointments.
• Examine the policyholder’s records, gather data to determine correct classifications for business activities and write an effective description of operations.
• Prepare complete audit document, explain results to insured and communicate the results to the home office.
• Travel to multiple audit locations.
• Hybrid position - work from home and complete remote audits 2-3 days per week.

Premium Auditor

• Independently conducts comprehensive audits of all accounting records of the bank
• Exercises discretion in planning audits, performing walk-throughs, assessing risks and controls, executing fieldwork
• Communicates audit findings and strategic recommendations to senior management
• Develops and negotiates Corrective Action Plans during audit fieldwork
• Drafts comprehensive audit reports detailing scope, observations, management discussion items, and enhancement opportunities
• Collaborates with Bank Examiners and External Auditors during examinations and audits
• Designs and revises audit procedures and internal control questionnaires as required
• May focus on specialized areas requiring advanced expertise

• 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

• The Premium Insurance Field Auditor conducts insurance policy audits for Worker’s Compensation, Auto and General Liability policies.
• This is done by auditing the policyholder’s records according to client company standards.
• If you are looking for a fast paced, self-motivating work environment from home, this job may be for you!
• Working from your home office, this role requires scheduling appointments with the insured to be audited, and travel on an average of 4 days per week within your assigned territory to meet with the insured and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards.
• Territory: Miami, FL. and surrounding areas

Premium Insurance Field Auditor

• Performing physical and remote audits of insured’s business
• Interviews, investigates, collects, and records information to be used in a written report that is provided to the insurance carrier

Insurance Field Auditor

• Conducts insurance policy audits for Worker’s Compensation, Auto and General Liability policies.
• Scheduling appointments with the insured to be audited.
• Travel on an average of 4 days per week within your assigned territory to meet with the insured.
• Obtain necessary documentation for insurance company client audits while adhering to customer requirements and quality standards.

Experienced Premium Insurance Field Auditor

• Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities
• Assess DRG, PDx, secondary Dx, PCS, POA and all other components of documentation that impact quality metrics
• Consistently assures coding practices remain compliant with coding guidelines and regulations
• Continually identifies educational opportunities related to coding and documentation
• Expert educator to clinical teams and medical staff
• Identifies strategic plans that will result in a positive impact to the clinical dashboard
• Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets
• Ability to multi-task a variety of audits
• Ability to analyze data and construct appropriate action plans
• Develops teaching tools to promote quality outcomes
• Is an active member of clinical and executive meetings as identified
• Advanced understanding of quality metrics for health system (Vizient, PSI, USNWR)
• Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and assists the Managers of Clinical Documentation and Coding in implementing key strategies to effect change.
• Partners with Coding, Clinical Documentation leadership and Medical Directors to coordinate, maintain, and execute advanced project work that includes but, is not limited to, Mortality Review, HAC/PSI Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.
• Partners with NM departments that includes but is not limited to: IT; Analytics; and Innovation to design and implement new and advanced workflow solutions.
• Partners with third-party consultants/partners to contribute to workflow and methodology build and refine as necessary.

Coding Quality Auditor, Specialist

• Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
• Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
• Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
• Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
• Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
• Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
• Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
• Manage the implementation process improvements that will maximize risk adjustment factor increases.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Auditor, Risk Adjustment

• Leads and performs complex internal audits and coordinates related large-scale projects.
• Identifies, documents, and analyzes audit findings and develops audit programs that address and test identified key risks.
• Performs follow-up audits and monitoring to ensure appropriate adherence to policies and procedures.
• Monitors compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation.
• Evaluates opportunities for improvement, develops recommendations, and presents improvement opportunities/audit findings to leadership.
• Acts as a resource to educate, consult and collaborate with staff on various audit related topics.
• Guides and educates departments on methods to decrease risk and increase compliance in organizational-wide programs, policies, and procedures.
• Assists the independent external auditors by gathering information, answering questions, executing testing, coordinating any further assistance needed, and performing related projects.
• Assists with establishment of annual audit plans by leading discussions with management to identify timing, scope and objectives of audits.
• Assists with the coordination of risk models/assessments to identify and develop an audit plan to address potential risks for specific audit scope areas.
• Ensures alignment of audit and project plans with risk assessment.

Senior Internal Auditor – Compliance

• Delivering BSI’s audit services to assigned clients in accordance with all BSI, scheme and regulatory requirements
• Conduct various types of audits
• Prepare assessment reports and deliver findings to clients to ensure client understanding of the assessment decision
• Recommend the issue, re-issue or withdrawal of certificates, and report recommendations
• Maintain overall account responsibility and portfolio accountability for nominated accounts
• Lead assessment teams as required
• Responsible for contacting clients and scheduling visits, planning the assessments, making travel plans, conducting assessments, reporting and managing the results
• Responsible for attending any required training and following all procedures, processes, policies within BSI
• Responsible for monitoring client accounts to ensure satisfaction is maintained
• Responsible for leading teams and mentoring new or inexperienced colleagues as needed
• Any other assignments as needed to meet assessment delivery business objectives

Aerospace Management Systems Auditor – East Coast

• Lead independent, objective assurance and consulting activities designed to evaluate and assess the effectiveness of the Bank’s governance, risk management and control processes
• Independently own the successful execution of the end-to-end audit process
• Establish direction for staff on more complex audit activities and project deliverables
• Develop and promote a workplace culture that values diversity of thought and promotes integrity
• Engage as a team player while operating within industry best practices, regulations, and internal and external professional practice expectations
• Effectively manage executive relationships and exhibit a high standard of performance and professional conduct
• Identify and understand risks and controls in changing environments
• Perform risk assessments and analyze macro-level risk trends
• Maintain compliance with audit methodology and applicable standards and regulations
• Establish audit scope inclusive of key risks relevant to the areas under review
• Assign and review the staff selected for audit engagements to ensure appropriate skillsets for execution
• Review and challenge audit staff and judgment to ensure accuracy
• Provide constructive input to Audit & Finance Committee and Management reporting

IT Enterprise Applications Auditor, Vice President

• Participate in research, training, scheduling, and other administrative and technical functions.
• Meet challenging client requirements and provide services with strong communication, interpersonal, analytical, and research abilities.
• Perform and design audit procedures and prepare financial statements.
• Execute the day-to-day in-charge auditor activities of various clients.
• Identify and communicate accounting and auditing matters to managers and engagement principals.
• Interact with clients to help ensure the information flow from the client to the audit team is efficient.
• Perform research on new audit and accounting standards and/or complex topics and share with the team.

Auditor, Governmental

• Perform internal QMS audits in accordance with applicable QMS standard(s) and internal requirements
• Develop and manage audit plans and schedules
• Conduct risk analysis to determine audit focus areas
• Support and advise site management on preparation for third party audits
• Perform benchmarking of enterprise best-practices
• Review complex proposals, contracts, regulatory, program and customer requirements for effective implementation in QMS
• Advise leadership on development of business strategies influencing directives and policies
• Consult in high level reviews of corrective actions at site, enterprise and customer level to assure trends and systemic issues are identified
• Conduct research, compile and analyze performance reports and process control statistics for continuous improvement
• Represent Company on industry working groups to develop industry standards for quality as needed

Senior Internal Quality Auditor, Level 3/4

• Conducting financial/operational audits.
• Internal control assessments.
• Strategy reviews.
• Special projects and risk assessment activities.
• Lead the development and execution of high quality assessments of the Company’s complex processes and controls.
• Identify risks and collaborate with team leadership, business management and external auditors on audit planning, testing and evaluation procedures.
• Prepare clear, accurate and concise audit work papers.
• Present findings/deficiencies to the lead auditor with recommendations for remediation.
• Review work performed by others and provide recommendations for improvement.
• May support internal and external audit/compliance groups with various activities.

Senior Internal Auditor

• Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation
• Identifies, documents, and evaluates business risks
• Develops written audit programs
• Conducts testing and analysis of existing controls to determine adequacy and effectiveness
• Prepares written work papers to document testing results and conclusions reached
• Documents issues, the causes of those issues, and their effects on the process/function and the corporation
• Serves as Lead Auditor on more complex audit assignments
• Drafts recommendations to limit risks and improve processes, functions and activities
• Writes audit reports for corporate executive management
• Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws
• Conducts testing of corrective actions as identified
• Develops detailed reports on each audit conducted
• Prepares reports of findings and recommendations for management
• Provides training to and assists or leads other auditors in completing their assignments

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