Auditor

• Collaborate with audit team members as well as members of IT to develop audit objectives, engagement scopes, and testing strategies aligned with departmental standards and risk priorities.
• Assist in the planning, execution, and reporting of IT audit engagements, including SOX ITGC testing, risk-based technology reviews, and issue validation procedures.
• Analyze and summarize data to identify control deficiencies, process inefficiencies, or noncompliance with policies, procedures, or regulations.
• Communicate findings and recommendations to audit leadership and business stakeholders in a clear manner.
• Monitor issued audit findings, perform validation testing over defined remediation plans, and present remediation statuses to stakeholders.
• Identify opportunities to strengthen controls, improve operational effectiveness, and reduce risk exposure across technology and business processes.
• Other duties as assigned

IT Auditor I

• Support issue resolution in the Oscar claim environment.
• Responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis.
• Report into the VP, Payment Integrity.
• Develop and maintain expertise on CPT, HCPCS, and ICD-10 Coding guidelines.
• Perform thorough and complex policy updates or audits of assigned documentation on both a prepayment and/or post payment basis.
• Document findings including reference to sources used to support decision making.
• Create reports and reference guides for other team members.
• Assist in drafting written communications to providers.
• Participate in educational calls with providers.
• Assist in the training of new team members.
• Develop and document processes to improve efficiency and effectiveness.

Senior Coding Auditor

• Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
• 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

Clinical Provider Auditor I

• 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

• Audit information system applications to ensure appropriate controls
• Evaluate security controls, identify vulnerabilities, and recommend improvements
• Perform IT audit and cybersecurity-focused consulting engagements
• Collaborate with internal audit team members to align IT audit coverage with enterprise cyber risk priorities
• Develop communication skills for discussing security findings and risk acceptance decisions

Internal Auditor – Technology

• Provides systematic and strategic approaches related to the effectiveness of risk management control and governance processes
• Examines and evaluates organization processes, reporting findings back to management regarding possible improvements and corrections
• Develop internal audit scope and audit plans
• Assists in audits within the organization's internal operations as directed by leadership
• Prepare and present reports that reflect audit results and document processes
• Typically follows existing procedures to perform routine assignments and to solve standard problems
• Analyzes basic information and standard practices to make decisions impacting work performed
• Individual contributor working with direct oversight
• Performs all other duties as assigned by management

Auditor jobs in Kentucky

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IT Auditor I

Senior Coding Auditor

Clinical Provider Auditor I

Quality Auditor, Hospital Bill Audits, Itemized Bill Review

Internal Auditor – Technology

Internal Auditor I