Auditor

• Reviews of complex proposals, contracts, regulatory, program and customer requirements ensuring they are effectively implemented in the Quality Management System (QMS)
• Represents the Company on industry working groups to develop industry standards for quality
• Advises senior leadership on development of business strategies that influence directives and policies
• Advises multi-function groups on development of processes, procedures and metrics to assure program, contract, customer, regulatory, statutory and AS9100 requirements are deployed
• Consults in high level reviews of corrective actions at the site, enterprise and customer level to assure that trends or systemic issues are identified and advises on development and implementation of corrective actions
• Conducts research, compiles and analyzes performance reports and process control statistics to continuously improve process capability
• Conducts business unit risk analysis to determine audit focus areas
• Develops and manages business unit audits plans and schedules
• Trains and advises senior management on preparation for third party audits
• Performs benchmarking of enterprise best-practices

Senior Quality Auditor – Virtual

• 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

• 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

Internal Auditor I

• 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

• Complete assigned audits at automotive repair facilities in accordance with OEM and manufacturer guidelines, based on site availability and scheduling
• Complete monthly vehicle inventory at dealerships by the assigned deadline, which offers flexibility to determine when work is completed
• Conduct required visual inspections while accurately documenting vehicle and audit information
• Ensure timely, accurate data is submitted to support our audit programs, reporting, and automotive market valuation
• Work independently while meeting quality standards and assigned deadlines

Vehicle Inventory Representative, Auditor

• Perform independent assessments of governance, risk management, and control processes across the organization.
• Lead smaller scope audits, evaluate compliance with regulations, legislation, and enterprise contracts.
• Identify opportunities to recover unreported value.
• Collaborate with cross-functional stakeholders, leverage data mining and analytical tools to conduct research and testing, and provide recommendations that strengthen business processes and controls.
• Thrive in a team-oriented environment while independently managing multiple priorities with minimal oversight.
• Develop audit programs and testing procedures to assure compliance with lower-risk Vizient contracts, internal controls, and organizational policies.
• Verify contractual compliance by designing and performing analyses using disparate data sources and multifaceted contract terms.
• Communicate non-compliance issues and recommendations through clear, concise, and organized communications tailored to the audience’s needs.
• Adhere to the Quality Assurance and Improvement Program (QAIP) throughout all phases of audit projects.

Auditor, Compliance

• Leads audit procedures including conducting interviews, reviewing documents, preparing working papers, and composing audit reports.
• Leads audit fieldwork, including identifying and defining issues, developing testing criteria, reviewing and analysing evidence, and documenting processes and procedures.
• Interfaces directly with local management by leading opening and closing meetings for projects.
• Monitors and reports audit activity status to Project Manager in line with project scheduling.
• Communicates the results of audit and advisory projects via written reports and oral presentations to the Project Manager and local management.
• Develops and maintains productive stakeholder, team, and management relationships through individual contact and group meetings.
• Assists Audit Managers and Directors with identifying and evaluating the organization’s risk areas and provides key input to the development of the audit work programs.
• Pursues professional development opportunities, including external and internal training and professional association memberships, and shares information gained with co-workers.
• Provides, or assists in providing, training, coaching and guidance to global team members.

Senior Internal Auditor

• Audit and monitor clinical documentation and service records for accuracy and compliance
• Utilize audit tools and reporting systems aligned with regulatory and reimbursement requirements
• Identify documentation trends, gaps, and compliance concerns, and communicate findings appropriately
• Support clinical documentation improvement efforts through education and follow-up auditing
• Collaborate with internal teams, including finance and patient accounting, on documentation and claims review processes
• Review coding and documentation using ICD-10 and CPT standards
• Generate and analyze reports to support compliance monitoring and operational improvement
• Maintain working knowledge of the organization’s electronic health record (EHR) systems
• Communicate effectively with providers, staff, and interdisciplinary teams

Compliance Auditor

• Conducts insurance policy audits for Worker’s Compensation, Auto and General Liability policies
• Audits the policyholder’s records according to client company standards
• Schedules appointments with the insured to be audited
• Obtains necessary documentation for audits while adhering to customer requirements and quality standards

Premium Insurance Auditor

• 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

• Extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes
• Reviews inpatient hospital claims for proper reimbursement
• Handles provider disputes in a result-oriented and metrics-driven environment
• Contributes to overall cost reduction by increasing the accuracy of provider contract payments
• Ensures correct claims payment and appropriate diagnosis related group (DRG) assignments
• Analyzes, enters and manipulates database
• Responds to or clarifies internal requests for medical information

• You'll serve as a trusted resource by providing education, guidance, and feedback to providers and physicians to support compliance, coding accuracy, and strong documentation practices.
• Responsibilities will include auditing outpatient records, assigning appropriate ICD-10-CM and CPT-4 codes, and abstracting key data for audit review, tracking, reporting, and reimbursement.
• Audits and reviews documentation for compliance with coding regulations.
• Provides educational opportunities for coders, practice managers and providers within Logan Health.
• Coordinates all Logan Health internal and external audits.
• Assists with the development and implementation of an internal audit program that provides feedback and education to providers of Logan Health.
• Provides ad hoc coding audits as requested.
• Performs audits for providers and follows up with meetings and assistance as needed.
• Notifies leadership of coding errors per department procedure.
• Provides accurate coding for claims as assigned.

Coding Auditor

• Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures
• Gathers findings at a macro level and makes recommendations for process improvement and efficiencies
• Performs professional responsibilities with direct supervision on method and processes
• Performs other duties assigned

Quality Auditor

• Planning and executing various financial audits and advisory engagements
• Developing work papers that adequately support audit findings
• Evaluating complex processes, risks, and internal controls
• Documenting observations and recommendations and presenting findings to Senior Audit Leadership
• Performing and overseeing internal control testing
• Assisting Audit Management by conducting risk assessments and developing audit programs
• Leading teams in execution of assurance and advisory engagements

Auditor, Team Lead/Senior Team Lead

Coding Quality Auditor and Specialist

• Provide patient focused, standardized, compliant revenue cycle support
• Assist Providence St Joseph Health in meeting financial objectives
• Thrive in a culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect

Revenue Cycle Auditor, RN

• Performing clinical, billing, coding and lowest cost setting reviews for services pre and post payment
• Utilizing medical, contractual, legislative, policy, and other information to validate claims submitted and billed
• Conducting research and preparing documentation of findings
• Consulting with medical directors as needed
• Coordinating with all departments involved in each case required
• Performing itemized bill review for high dollar claims and reimbursements

Coding Investigator Auditor

• review of information provided in medical records
• understanding of what each line of business allows
• knowledge of Evaluation & Management (E&M) codes
• communicate audit findings confidently
• analyze information and clarify internal requests for medical information
• follow established guidelines/procedures
• perform most work 5 days per week, 8 hours per day between 6AM-6PM

Medical Coding Auditor

• Build and maintain strong relationships with key business stakeholders to support audit engagement success and promote collaboration
• Independently assesses functions and activities to evaluate operational effectiveness and control adequacy
• Plan and scope audits that align with organizational priorities and risk profiles
• Analyze complex data and evidence to form objective, actionable insights
• Communicate findings clearly and persuasively to senior leadership
• Prepare high-impact audit reports tailored to stakeholder needs
• Monitor finding remediation efforts and provide strategic guidance on risk mitigation
• Serve as a subject matter expert and escalation point for complex issues
• Mentor junior team members, fostering a culture of excellence and continuous improvement
• Contribute to cross-functional initiatives and strategic projects

Senior Internal Auditor – Information Technology, IT

• Perform internal audits, including the execution of information technology, strategic, operational, financial, and compliance risk-based audits
• Execute risk-based audits evaluating controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies
• Assist in audit planning, refinement of audit work programs, and wrap up of engagements
• Assist in drafting audit reports that summarize audit findings and recommendations
• Develop and communicate audit observations, recommendations, process improvement opportunities, and best practices and obtain management responses
• Monitor and report on the status and findings of audits
• Assist audit team in performing special projects and implementing internal audit best practices
• Performs other duties as assigned

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