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

• 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

Premium Auditor – Entry Level

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
• Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.

Outpatient Coding Auditor

• Lead and conduct complex financial audits related to Medicaid and CHIP, ensuring compliance with state and federal requirements.
• Evaluate financial management practices, internal controls, and payment integrity across Medicaid programs.
• Analyze large-scale financial datasets to identify trends, risks, improper payments, and opportunities for improved financial performance.
• Prepare detailed audit reports including findings, recommendations, and corrective action guidance.
• Collaborate with cross-functional teams, program integrity groups, and state/federal stakeholders to support strategic financial oversight initiatives.
• Support proactive, high‑quality financial management activities aligned with CMS oversight priorities, similar to responsibilities defined under Medicaid Financial Oversight Analysis efforts.
• Ensure audit activities are aligned with best practices in federal program stewardship and financial integrity.

Senior Medicaid Financial Auditor

• Develops and implements strategic needs analyses and training plans for coding leadership
• Coordinates and evaluates curriculum development
• Conducts the preparation and delivery of training for Medical Coders
• Provides guidance and leadership to coding and billing management
• Performs annual performance reviews and quality assurance reviews
• Serves as a subject matter expert for professional fee coding
• Ensures information meeting professional coding standards is accurate and current
• Monitors and audits inpatient and outpatient accounts
• Assesses educational needs of coding staff
• Develops programs or researches educational resources
• Assists with training new and existing staff
• Coordinates the presentation of ongoing professional seminars and materials
• Performs miscellaneous job-related duties as assigned
• Provides reports of audit findings to coding management and leadership

Physician 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

• leads day-to-day activities of the audit team
• provides allocation of resources
• establishes priorities
• manages vendor relationships
• periodically audits work of vendors
• conducts provider meetings to discuss audit findings
• negotiates settlements
• researches claims payment methodologies
• prepares and analyzes reports on recoveries

Clinical Provider Auditor Lead – Behavioral Health

• The Inpatient Coding Quality Analyst serves as a subject matter expert responsible for validating the accuracy, completeness, and compliance of ICD‑10‑CM/PCS coding and MS‑DRG/APR‑DRG assignment through both random and targeted audits of inpatient medical records.
• Evaluates complex clinical documentation and coding scenarios, resolves inpatient claim and coding edits, supports denial prevention and appeal activities, and collaborates with Revenue Cycle, Central Business Office (CBO), CDI, Compliance, Internal Audit, and clinical stakeholders.
• Provides actionable recommendations to improve coding accuracy, compliance, education strategy, and operational workflows.
• Conducts pre-bill and post-bill audits of high-risk, high-dollar, and regulatory-sensitive inpatient cases to ensure accurate code assignment.
• Supports denial mitigation and appeal efforts, validates failed or rejected inpatient claims, and collaborates with Revenue Cycle teams to ensure accurate and compliant billing.
• Serves as a coding quality resource and educator, providing expert guidance to inpatient coding staff and participating in formal education sessions.

Inpatient Coding Quality Analyst, Auditor

• Travel daily throughout a defined territory *Company Vehicle Provided*
• Conduct entry-level commercial energy audits for small and mid-sized facilities
• Engage directly with customers and contractors to explain program offerings, encourage participation, and address basic questions
• Accurately document inspections, installations, and customer interactions in accordance with program requirements
• Perform on-site installation of energy efficiency measures, including physical labor and use of basic tools
• Identify, troubleshoot, and escalate basic technical or installation issues to program staff as needed

Commercial Energy Auditor

• We are hiring an Auditor or Senior Auditor based on skills, experience, and demonstrated scope of impact.
• In this role, you will evaluate and improve the effectiveness of the organization’s risk management, control, and governance processes through internal assurance and consulting engagements, collaboration with business partners, and support of external audit and regulatory examination activities.
• Position level will be determined based on the individual’s skills, knowledge, and experience.
• Perform internal assurance and consulting reviews to evaluate the effectiveness of risk management, control, and governance processes.
• Use audit evidence, analysis, and root cause thinking to identify observations, risks, and practical improvement opportunities, and communicate findings through written reports and verbal discussions.
• Collaborate with business partners to recommend process and internal control changes that balance company and customer interests.
• Assist external auditors with interim and year-end external audits and support coordination of regulatory financial examinations.
• Support assigned projects and audit-related activities, which may include control certification work, audit planning support, system implementation reviews, automation initiatives, or process redesign efforts depending on level.
• At more advanced levels, provide mentorship, guidance, and support to less experienced auditors.

Auditor, Senior Auditor

• Audit and authorize reimbursement of specific medical stop loss claims
• Effectively mitigate client medical stop loss claims and provide excellent customer service
• Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier
• Recognize cost mitigation opportunities
• Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits
• Initiate claims investigations and vendor referrals
• Interpret plan language and identify experimental services and subrogation opportunities
• Identify need for follow-up on pended claims and resolution
• Communicate effectively with carriers, vendors, and management
• Provide full claims service to both phone and written inquiries
• Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history
• Develop new and review old stop loss claim forms
• Assist with internal auditing of claims auditors and training of claims auditors

Senior Auditor, Stoploss Claim

• Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services
• Conduct internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls
• Identify, document, and evaluate business risks
• Develop written audit programs
• Conduct testing and analysis of existing controls to determine adequacy and effectiveness
• Prepare written work papers to document testing results and conclusions reached
• Document issues, the causes of those issues, and their effects on the process/function and the corporation
• Serve as Lead Auditor on more complex audit assignments
• Draft recommendations to limit risks and improve processes, functions, and activities
• Write audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations
• Collect and analyze data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies
• Conduct testing of corrective actions as identified
• Develop detailed reports on each audit conducted

Auditor III

• Working with pre-certification / authorization / denials teams to assist in obtaining up front authorization for services rendered.
• Assisting with denial management and resolution.
• Collaborating with HIM, PFS, Case Management and multiple clinical departments to resolve account problems related to authorization of services and account resolution.
• Reviewing protocols to assist in ensuring services being billed as standard of care are evidenced based and meeting industry guidelines.
• Evaluating and resolving issues related to the revenue cycle including medical documentation, utilization review and medical necessity.
• Providing training to improve revenue cycle processes.
• Recommending policies and procedures improvements to increase efficiencies
• Supporting process improvement activities to assure medical record compliance

Clinical Nurse Auditor – Rev Cycle

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
• Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Draws on advanced ICD-10 coding expertise to substantiate conclusions.
• Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Consistently achieves productivity and quality performance standards established by management.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

Coding Auditor

• Conduct clinical reviews to verify the accuracy of skilled nursing facility billing.
• Apply CMS clinical guidelines and payer-provider contract terms and policies to a variety of claim scenarios to identify overpayments for claims paid under PDPM, RUG, and contracted per diem payment methodologies.
• Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data Set assessment.
• Document accurate audit results in a clear, concise, and effective manner using applicable EXL tools, CMS guidelines, payer contractual terms and policies.
• Utilize proprietary workflow systems efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
• Meet or exceed EXL established program productivity and quality goals.
• Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
• Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Auditor III, Healthcare – Skilled Nursing Facility / Resource Utilization Group

• 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

• Lead the execution of independent testing of IT General Controls (ITGCs)
• Evaluate the design and operating effectiveness of IT controls
• Document testing procedures and results to meet quality standards
• Independently validate the remediation of open SOX findings
• Assess management’s remediation actions before closing findings
• Track remediation progress and report status to Internal Audit leadership
• Serve as a trusted Internal Audit point of contact for IT control owners
• Contribute to Internal Audit reporting to the Audit Committee

SOX Auditor – IT Controls Manager

• Participate in meeting Internal Audit's overall business objectives
• Lead an assortment of projects including operational and financial audits, SOX 404 compliance, investigations, special projects, management requests, data analysis, etc.
• Supervise staff auditors to execute audit plan
• Build strong working relationships with management and team
• Analyze complex information and solve problems independently

Senior Auditor – Hybrid: Onsite, Remote Work

• Examine key financial, operational and IT processes and risks
• Test controls to mitigate risks and effectively conclude on test results
• Identify and evaluate risks and control design
• Assist our external auditors with testing Hartford key controls
• Lead audits and projects from scoping to reporting and delivering audit recommendations to management
• Produce clearly documented work papers of work performed
• Design data extracts to detect potential issues or quantify findings
• Independently build analytic use cases/tools or collaborate with Audit Analytics Engineers on complex projects
• Work both independently and in a team environment to maximize performance
• Demonstrate leadership through engagement and personal development
• Manage demand and capacity to drive team performance and achieve Audit Committee objectives

See all jobs on JobTailor

Hospital Coding Auditor

Premium Auditor – Entry Level

Premium Auditor – Entry Level

Outpatient Coding Auditor

Senior Medicaid Financial Auditor

Physician Coding Auditor

Clinical Provider Auditor I

Clinical Provider Auditor Lead – Behavioral Health

Inpatient Coding Quality Analyst, Auditor

Commercial Energy Auditor

Auditor, Senior Auditor

Senior Auditor, Stoploss Claim

Auditor III

Clinical Nurse Auditor – Rev Cycle

Coding Auditor

Auditor III, Healthcare – Skilled Nursing Facility / Resource Utilization Group

Quality Auditor, Hospital Bill Audits, Itemized Bill Review

SOX Auditor – IT Controls Manager

Senior Auditor – Hybrid: Onsite, Remote Work

Senior Auditor / Advanced Staff Auditor