Auditor jobs in Richmond, VA - 69 jobs

**Be Part of an Extraordinary Team** Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. **Build the Possibilities. Make an Extraordinary Impact.** **Title** : DRG Coding Auditor (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG) **Virtual: ** _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ **Alternate locations may be considered if candidates reside within a commuting distance from an office.** The **DRG Coding Auditor** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending physician's statement sent in by acute care hospitals on submitted DRG. **Primary duties may include, but are not limited to:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters. + Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing). + Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and HACs. + Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations. **Minimum Requirements:** + Requires at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing. + Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder. + Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. **Preferred Skills, Capabilities and Experiences** : + BA/BS preferred. + Experience with vendor based Diagnosis-Related Group (DRG) Coding/Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred. + Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $95,172 to $149,556. **Location(s):** Colorado; Illinois; Maryland; Minnesota; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Work Schedule Standard (Mon-Fri) Environmental Conditions Laboratory Setting, Office, Some degree of PPE (Personal Protective Equipment) required (safety glasses, gowning, gloves, lab coat, ear plugs etc.) Job Description This is a fully onsite role based at our BioAnalytical Laboratory in Richmond, VA. We welcome applicants from all locations within the US. Please note that relocation assistance is not provided for this position, and any relocation costs will be the responsibility of the candidate. Must be legally authorized to work in the United States without sponsorship. Must be able to pass a comprehensive background check, which includes a drug screening. The working schedule for this role is Monday - Friday from 8AM-5PM. At Thermo Fisher Scientific, you'll discover meaningful work that makes a positive impact on a global scale. Join our colleagues in bringing our Mission to life - enabling our customers to make the world healthier, cleaner and safer. We provide our teams with the resources needed to achieve individual career goals while taking science a step beyond through research, development and delivery of life-changing therapies. With clinical trials conducted in 100+ countries and ongoing development of novel frameworks for clinical research through our PPD clinical research portfolio, our work spans laboratory, digital and decentralized clinical trial services. Your determination to deliver quality and accuracy will improve health outcomes that people and communities depend on - now and in the future. Location/Division Specific Information Our PPD Laboratory Services team has a direct impact on improving patient health through the expertise of scientists, industry thought-leaders and therapeutic authorities. As the world leader in serving science, our laboratory professionals bring their commitment to accuracy and quality to deliver groundbreaking innovations. Discover Impactful Work Conducts internal and/or external audits to ensure compliance with established quality assurance processes, standards, global regulatory guidelines and/or client contractual obligations. Identifies and applies company policies and procedures to resolve routine issues. Delivers billable quality services for clients and projects. This role assures the quality of lab data and reports. A Day in the Life • Audits laboratory data for compliance with methods and standard operating procedures and report findings • Audits sample result tables and analytical reports for completeness and accurate representation of the data and report findings • Serves as a resource to operational departments on audit or quality assurance subject matter • Assists in the preparation of audit findings and/or other related information Keys to Success Education and Experience Bachelor's degree or equivalent and relevant formal academic / vocational qualification; Associates' degree and relevant experience is acceptable in lieu of Bachelor's degree Previous QA or lab experience that provides the knowledge, skills, and abilities to perform the job (comparable to 1-2 years'). In some cases an equivalency, consisting of a combination of appropriate education, training and/or directly related experience, will be considered sufficient for an individual to meet the requirements of the role. Knowledge, Skills and Abilities • Familiar with applicable GxP and appropriate regional regulations • Thorough working knowledge of SOPs and WPDs • Excellent oral and written communication skills (including appropriate use of medical and scientific terminology) • Strong attention to detail • Able to work independently or in a team environment • Strong problem solving abilities • Strong organizational and time management skills • Basic computer skills and ability to learn and become proficient with appropriate software • Proven flexibility and adaptability • Valid driver's license and ability to qualify for and maintain a corporate credit card with sufficient credit line for business travel Work Environment Thermo Fisher Scientific values the health and wellbeing of our employees. We support and encourage individuals to create a healthy and balanced environment where they can thrive. Below is listed the working environment/requirements for this role: • Able to communicate, receive, and understand information and ideas with diverse groups of people in a comprehensible and reasonable manner. • Able to work upright and stationary and/or standing for typical working hours. • Able to lift and move objects up to 25 pounds. • Able to work in non-traditional work environments. • Able to use and learn standard office equipment and technology with proficiency. • May have exposure to potentially hazardous elements, including infectious agents, typically found in healthcare or laboratory environments. • Able to perform successfully under pressure while prioritizing and handling multiple projects or activities. Benefits We offer competitive remuneration, annual incentive plan bonus, healthcare, and a range of employee benefits. Thermo Fisher Scientific offers employment with an innovative, forward-thinking organization, and outstanding career and development prospects. We offer an exciting company culture that stands for integrity, intensity, involvement, and innovation! Our Mission is to enable our customers to make the world healthier, cleaner and safer. Watch as our colleagues explain 5 reasons to work with us. As one team of 100,000+ colleagues, we share a common set of values - Integrity, Intensity, Innovation and Involvement - working together to accelerate research, solve complex scientific challenges, drive technological innovation and support patients in need. #StartYourStory with PPD, part of Thermo Fisher Scientific, where diverse experiences, backgrounds and perspectives are valued. Apply today! **************************** Thermo Fisher Scientific is an EEO/Affirmative Action Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability or any other legally protected status. Accessibility/Disability Access Job Seekers with a Disability: Thermo Fisher Scientific offers accessibility service for job seekers requiring accommodations in the job application process. For example, this may include individuals requiring assistance because of hearing, vision, mobility, or cognitive impairments. If you are a job seeker with a disability, or assisting a person with a disability, and require accessibility assistance or an accommodation to apply for one of our jobs, please submit a request by telephone at ***************. Please include your contact information and specific details about your required accommodation to support you during the job application process. *This telephone line is reserved solely for job seekers with disabilities requiring accessibility assistance or an accommodation in the job application process. Messages left for other purposes, such as not being able to get into the career website, following up on an application, or other non-disability related technical issues will not receive a response

WelbeHealth PACE (All-Inclusive Care for the Elderly) program provides seniors with the opportunity to continue living in their homes and in their communities. Our innovative and comprehensive range of medical services to participants is what ignites our passion to treat the whole person and not the symptoms! We employ a collaborative interdisciplinary team (IDT) approach to evaluate and guide participant care, which is key to WelbeHealth values, team culture, and mission. At the direction of the Coding Supervisor, the Coding Auditor and Educator focuses on ensuring coding is accurate and properly supported by clinical documentation within the health records, as well as educating our teams on best practices to promote compliance. **Essential Job Duties:** + Assist with retrospective and concurrent coding for PACE (All-inclusive Care for the Elderly) Dual participants + Conduct pre-visit chart preparations and post-visit chart reviews + Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustments diagnosis coding guidelines + Work closely with Coding Supervisor in identifying opportunities for HCC coding education **Job Requirements:** + Associates Degree preferred; three (3) years of relevant experience may be substituted in lieu of a degree + Minimum of four (4) years of related experience or a combination of healthcare-related education and experience in coding and auditing + Minimum of two (2) years of Risk Adjustment (HCC) coding experience in a managed care environment + Current CCS, CCS-P, CPC, CPC-H, CPMA, or CRC credential + Strong knowledge of ICD-10 coding standards + Experience in the correct application of M.E.A.T. concepts + Comfortable in Microsoft Office (Outlook, Word, Excel, and PowerPoint) **Benefits of Working at WelbeHealth:** Apply your coding expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for. + Medical insurance coverage (Medical, Dental, Vision) + Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time + 401 K savings + match + Advancement opportunities - we've got a track record of hiring and promoting from within, meaning you can create your own path! + Equity grants - typically reserved for executives, we want all team members to celebrate our success as a rapidly scaling company + And additional benefits Salary/Wage base range for this role is $68,640 - $89,535 / year + Bonus. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications. Compensation $67,829-$89,535 USD **COVID-19 Vaccination Policy** At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. **Our Commitment to Diversity, Equity and Inclusion** At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. **Beware of Scams** Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to ****************************

About Us ITC Worldwide Advisors, LLP is a rapidly growing, modern provider of professional services to the middle market, operating globally. Our mission is to instill confidence in a world of change. Enable Transformation while doing more with less! Our exceptional people are the cornerstone of our unique culture and talent experience. Responsibilities * Understand clients' needs and expectations, their business and industry, accounting and control systems, employees, company values, and industry-related GAAP and GAAS issues. * Develop an understanding of the ITC audit automation approach and ERP tools. * Assess risks and evaluate the client's internal control structure. * Perform substantive tests and tests of internal controls to identify and resolve accounting or reporting issues. *Prepare financial statements under prescribed formats. Required Skills and Qualifications * Completion of 90+ credit hours towards a B.A. / B.S. degree or equivalent from an accredited university in Accounting or Finance. * You must have passed your ACCA, CPA, CFA, or CIMA exam. N.B: We kindly request you to complete a brief survey. Your feedback will help us enhance the candidate experience and ensure we attract the best talent. **************************** **************************** **************************** Next Steps: Once you have completed the survey, please proceed with your job application as instructed. Learn more:****************************************************************

Title: Staff Auditor - Sports Betting State Role Title: Hiring Range: $63,776 - $83,000 Pay Band: UG Recruitment Type: General Public - G Job Duties For more than 34 years, the Virginia Lottery has been building an amazing organization committed to growth and giving back - and having fun while doing it. Operating entirely on revenue from game sales, rather than tax dollars, the Virginia Lottery generates more than $2.0 million per day for Virginia's K-12 public schools. The Virginia Lottery also licenses and regulates casino gaming and mobile sports betting. The Virginia Lottery, an independent state agency, is currently seeking a Staff Auditor to join its Gaming Compliance Department in its Headquarters location. The Staff Auditor is: Responsible for executing audits of our sports betting operators to ensure financial and operational integrity, accountability, efficiency and effectiveness, compliance with policies, procedures, laws, and regulations. Responsible for assessing internal controls and standard operating procedures to minimize the risk of fraud, waste, and abuse. Performs all audit functions to include reviewing financial records, performance data, and minimum internal control submissions from sports betting operators. Performs other duties as required or assigned. Executes all activities of Sports Betting Gaming Compliance Audit Department (45%): • Assists the Senior Auditor and Director of Audit - Gaming Compliance in planning and coordinating activities of the department's audit processes, procedures, and forms to support established regulations related to Sports Betting. • Executes all reviews and audits defined in the audit plan ensuring internal controls are compliant with regulations and minimum internal control standards are properly designed and operating effectively. • Continually analyzes business processes, the adequacy and effectiveness of internal controls, and compliance with internal control policies and procedures approved by the Virginia Lottery Gaming Compliance Department. • Tracks the status of all audits, forms, and any other information deemed relevant to audits and findings. • Works closely with the Senior Auditor and Director of Audit - Gaming Compliance in the preparation and execution of the Gaming Compliance audit program based on the annual risk assessment. • Continuously assists in the identification of business risks and provides assurance that risks are appropriately managed. • Proactively informs the Director of Audit - Gaming Compliance of significant risks or exposures related to internal controls, compliance, and/or governance requiring prompt attention. • Works with sports betting operators to identify improvements in the regulatory process. • Conducts interviews with Sports Betting Operators' personnel and performs unannounced reviews of their procedures to ensure that the operator is complying with documented minimum internal control standards. • Performs audits to ensure tax submissions are accurate, monitors suspicious activity reports, and conducts reviews to ensure operator compliance with responsible gaming requirements. • Maintains all records of audits, as well as other documents filed with the Virginia Lottery. Ensures that audits of all sports betting operators are in compliance with their minimum internal control standards and relevant regulations. This includes, but is not limited to, the oversight of audit functions including verifying, sampling, reviewing, confirming, observing, examining, and reporting in assigned areas. • Discusses audit findings and remediation plans with the Director of Audit - Gaming Compliance ensuring that reports are clear, concise, identify root causes with practical solutions, and ultimately provide value and meet compliance. • Obtain responses from Sports Betting Operators related to the root cause of any audit finding and proposed remediation. • Perform testing using Word, Excel and/or other audit software to prepare work papers to document audit procedures performed and support conclusions. • Collects and analyzes data to detect deficient controls. • Makes operational, system, or policy recommendations to the Director of Audit - Gaming Compliance to effectively accomplish the mission of the Department. • Effectively researches available data and compiles findings in response to investigative and/or administrative inquiries. • Prepare status reports and compile statistical information as requested by the Leadership Team. • Assists the Director of Audit - Gaming Compliance in planning and coordinating activities of the department's audit processes, procedures, and forms to support established regulations for the Commonwealth's Casino Operators. • Develops and maintains audit objectives based on the annual risk assessment and the probability of significant errors, fraud, and noncompliance. • Performs other duties as assigned. Minimum Qualifications • Knowledge of Generally Accepted Auditing Standards, Generally Accepted Accounting Principles, and the COSO Internal Controls Framework. • Familiarity with IT audit techniques and data analysis tools. • Excellent communication (oral and written) skills. • Ability to build effective working relationships with diverse groups of individuals. • Proficient in desktop applications such as, but not limited to, Microsoft Word, Excel, PowerPoint, Power BI, Tableau, and audit software. • Ability to clearly document audit findings, prepare management reports, and make logical and sound decisions in critical, complex, and changing situations. • Ability to develop and document procedures to create an efficient and effective workflow. • Demonstrated ability to effectively handle multiple priorities and /or competing tasks and responsibilities. • Excellent problem solving and conflict resolution proficiencies Additional Considerations Bachelor's Degree from an accredited 4-year college or university in Accounting, Finance, or related field or equivalent combination of education and experience is required. Minimum two years' experience in audit, finance, or accounting, or Sports Betting operations is required. Sportsbetting experience is highly desirable (preferably in Internal Audit, Revenue Audit, Compliance or Operations) Certified Public Accountant (CPA) or Certified Internal Auditor (CIA) or Certified Fraud Examiner (CFE) is preferred. Special Instructions You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position. Must complete Background Investigation. Valid driver's license, with satisfactory driving history. Minimal travel throughout Virginia will be required. Travel outside of Virginia as needed. Telework eligible including work from home 2 days a week. Contact Information Name: Human Resources Phone: ************ Email: N/A In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at ************. Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

360 IT Professionals is a Software Development Company based in Fremont, California that offers complete technology services in Mobile development, Web development, Cloud computing and IT staffing. Merging Information Technology skills in all its services and operations, the company caters to its globally positioned clients by providing dynamic feasible IT solutions. 360 IT Professionals work along with its clients to deliver high-performance results, based exclusively on the one of a kind requirement. Job Description We are looking to fill a position for Financial Auditor in Richmond VA. Qualifications Experience in accounting, internal controls or fiscal administration. Demonstrated experience working with complex financial systems, and analyzing financial reports and business processes. Degree from a college or university with major studies in accounting, public or business administration or related curriculum, or an equivalent combination of training and experience. Additional Information In person interview is acceptable.

PRIMARY FUNCTION: Assists the Internal Audit Department in completing the annual audit plan by performing financial and operational audits to assure that internal controls and procedures are in place to mitigate risks and comply with regulatory requirements and VACU's policies. JOB DUTIES AND RESPONSIBILITIES: Utilize critical thinking skills to objectively analyze and evaluate information, identify patterns, and make logical and reasonable judgments. Develops potential audit procedures with minimal guidance from department management and provides thought leadership to assigned staff member(s). Performs assigned audit procedures, including documenting audit objectives, identifying risks and controls, developing and executing an audit program, performing appropriate audit testing, and providing direction to other audit team members. Schedules and conducts entrance, follow up, and/or exit meetings with Credit Union Management, as requested. Identifies and evaluates opportunities for operational efficiency. Documents audit findings in automated working papers that support procedures performed and conclusions drawn. Effectively communicates audit results, risks, and/or recommendations for improvement, both verbally and in writing. Establishes positive working relationships with department staff and Credit Union team members at all levels. Prepares an audit report summarizing the results of the audits performed to Management and the Supervisory Committee. Carries out all aspects of assigned audits or projects in a timely manner, in accordance with established budgets and objectives. Provides assistance to the external auditors. Attends internal and/or external training classes and seminars to stay abreast of issues affecting the internal audit function and financial services industry. Maintains a good working relationship with employees at all levels. Keeps all Credit Union transactions and other information obtained through audit procedures in strict confidence. Comply with all published enterprise level policies and procedures including, but not limited to, Risk Management policies. Complete all required, ongoing enterprise level training including, but not limited to BSA, OFAC, and Information Security. Report all Risk Management Policy violations in accordance with policy. Performs other duties as assigned by the SVP/Chief Audit Officer. JOB QUALIFICATIONS: Education: Bachelor's degree with concentration in accounting or finance is required. Professional certification as a CPA, CIA, CISA, CFSA or other relevant certification is preferred. Work Experience: Two plus years prior experience in public accounting or internal audit. Prior experience working with a financial institution is preferred. Prior experience independently planning and conducting internal audits is desirable. An understanding of generally accepted accounting principles and/or internal auditing standards is required to determine compliance with policies and procedures and evaluate the effectiveness of internal controls. Strong computer skills are required, including proficiency in Microsoft suite of software; familiarity with Arbutus Analytics, Teammate, or other similar audit software is desirable. Skills: Good judgment and strong analytical skills; excellent communication and listening skills; excellent organizational and time management skills to prioritize and work on multiple projects; ability to work both within a team and independently; flexible; high degree of integrity and respect for confidentiality and privacy of information. Abilities: Must have transportation to all VACU locations. Physical Requirements This job requires the ability to sit and stand for long periods of time and infrequent lifting or carrying of objects up to 10 pounds.

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. **What We're Looking For:** As an Outpatient Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. In this role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace! ******Seeking a candidate to bring a strong skill set with regards to auditing ED, SDS, OBS and I&I as well as experience in ProFee including but not limited to E&M, IR, Spinal and Orthopedics.****** **What You Will Do:** + Performs Outpatient Facility coding audits of medical records and abstracts using ICD-10-CM, CPT, HCPCS, and modifiers and appropriate coding references for accurate coding assignment + Provides rich and concise rationale explaining the reasoning behind any identified changes, including specific references, location of documentation, etc + Keeps abreast of regulatory changes + Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution + Provides coder education via the auditing process + Function in a professional, efficient and positive manner + Adhere to the American Health Information Management Association (AHIMA)'s code of ethics + Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession + High complexity of work function and decision making + Strong organizational, teamwork, and leadership skills ******Seeking a candidate to bring a strong skill set with regards to auditing ED, SDS, OBS and I&I as well as experience in ProFee including but not limited to E&M, IR, Spinal and Orthopedics.****** **What You Need to Succeed:** + 5+ years of outpatient facility coding experience and/or auditing + CCS (preferred), RHIA or RHIT preferred + Maintains 95% accuracy rate + Experience with various software including Epic, Cerner, and other prevalent EMRs **What We Offer:** + Benefits for Full-Time employees: Medical, Dental, Vision, 401k Savings Plan w/match, 2 weeks of paid time off, and Paid Holidays, Floating Holidays + Free CEUs every year + Stipend provided to assist with education and professional dues (AHIMA/AAPC) If Applicable + Equipment: monitor, laptop, mouse, headset, and keyboard + Comprehensive training led by a credentialed professional coding manager + Exceptional service-style management and mentorship (we're in this together!) Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $35 - $45 an Hour Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $35-$45 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion. This job is not eligible for employment sponsorship. Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here (************************************************** . Know Your Rights (*********************************************************************** , explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way. Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, (************************************************************** Id=**********48790029&layout Id=**********48795462) by selecting the 'Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here (******************************************************************************************************* . Requests for reasonable accommodations will be reviewed on a case-by-case basis. For more information about how we collect and use your data, please review our Privacy Policy (**************************************** .

At James River Group, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. James River Group is a subsidiary of James River Group Holdings, Ltd. We are proud of our recent national recognition as a 2021, 2022, and 2023 Top Workplaces USA awards. James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance companies. The Company operates in two specialty property-casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company. Internal Auditor Job Summary The Internal Auditor will assist with, coordinate and execute all aspects of the internal audit process including but not limited to audit planning, performing audit work and testing as well as Sarbanes Oxley (SOX) compliance work and testing. Duties and Responsibilities * Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service * Perform and document SOX compliance planning and testing in accordance with developed test plans * Identify and document SOX exceptions * Identify and analyze SOX exceptions, process inefficiencies and internal control weaknesses to provide meaningful recommendations for improvement * Prepare SOX-related communications to Management and external auditors * Coordinate and execute internal audits in accordance with audit project work programs for financial, operational and IT audits * Prepare audit reports * Maintain all organizational and professional ethical standards * Communicate work product results and project status updates routinely with all members of Internal Audit department Knowledge, Skills and Abilities * Proficiency in MS Office (Word, Excel, Outlook, Access) * Knowledge of GAAP, insurance industry standards and/or IT systems * Research, analysis and problem-solving skills * Ability to exercise sound judgement in making critical and complex decisions * Ability to build effective relationships with business partners * Self-starter who works well independently and in a team environment * Ability to convey technical process information in a clear and concise manner * Ability to manage multiple tasks and projects effectively * Ability to identify and make process and procedure improvement recommendations * Strong organizational skills and attention to detail * Continuous learning style * Active listening skills * Excellent written and verbal communication skills * Ability to periodically travel both domestically and internationally (Bermuda) Experience and Education * High School diploma required * Bachelor's degree in related field (Finance, Accounting) preferred, or equivalent combination of education, training and experience * Minimum of one year of relevant work experience (accounting, audit, finance, information technology, insurance-related field) required * Certifications or progression towards professional certifications (Certified Internal Auditor Certified, Public Accountant) preferred #LI-AF1 #LI-Remote

You chart the course; we help you lift off. At YHB, we aren't limited by small-firm constraints or stuck in the big-firm mentality. Our culture is based on relationships between our teams and our clients. We aim to hire great people who want to take ownership of their careers while we help to provide the tools for success. Assurance Supervisors are responsible for the completion of various aspects of assurance engagements that have been assigned to them while developing subject matter expertise. They will begin to lead teams in understanding new assurance and accounting developments. They will take responsibility for the supervision and review of Associates' workpapers prior to Manager review. INDUSTRY FOCUS: Financial Institutions, Banking Roles and Responsibilities Technical Expertise and Work Quality Demonstrate a working knowledge of the technical aspects and issues related to their functional and industry specialization. Follow YHB guidance regarding secure use of hardware, software, and client information. Hold Associates accountable for protecting YHB assets and information. Maintain proficiency and identify efficiency with relevant firm technical resources and computer applications. Demonstrate effective use of these resources and use file and workpaper organization techniques. Continually strive to develop and maintain a high level of technical competence. Be capable of drafting professional correspondence to clients and superiors on complex subject matter. Draft formal communications that contribute to the planning and completion of the assurance engagement. Prepare workpapers that are neat, organized, and cross-referenced. Review workpapers prepared by Associates for accuracy, content, reasonable procedures, and supportable conclusions. Assign Assurance sections for Associates, allowing you to complete more technical and challenging Assurance sections. Complete assignments on time and within budget. Assign review comments to Associates on the engagements and verify the review comments have been appropriately addressed. Address review comments from the Manager and/or Principal. Provide input in the planning aspects of the engagement to improve quality and efficiency. Assist in preparation of current file and financial reporting requirements, if applicable to the engagement. Evaluate engagement performance and formalize suggestions for improvement of next year's engagement. Communicate with team members on job responsibilities (i.e., equipment responsibilities, dress code, and basic understanding of client) prior to arrival. Client Management and Service Maintain the complete confidentiality of firm and client information. Demonstrate an ability to work under time constraints; provide as much flexibility as possible when needed to meet client expectations and deadlines. Present yourself and your work product to clients and co-workers in a professional manner. Demonstrate working knowledge of clients' business needs by identifying issues and discussing resolutions with in-charge employees and implementing resolutions throughout the engagement process. Keep Managers, Principals, and Client Management informed of the engagement progress and issues as they develop. Develop and maintain strong, positive client relationships through timely communication during the engagement as well as periodic communication throughout the year. A commitment to respond to clients within 24 hours. Maintain daily time entry for accurate reporting firm wide. Business Development Recognize that practice expansion comes from existing clients as well as potential clients. Actively develop own referral network, recognizing that every interpersonal encounter may provide a business development opportunity. Participate in civic/professional organizations, as well as YHB marketing activities. Continue to gain an understanding of service capabilities. Develop a network of contacts and seek ways to increase firm visibility. Represent YHB publicly by accepting speaking opportunities, authoring articles for industry literature, YHB newsletters, etc. Personal Participation and Professional Development Assume responsibility for career growth by preparing personal development plans, tracking personal marketing activities, new business generation, identification of continuing education strategies, etc. Accept constructive input from and offer constructive feedback to Managers and Principals. Honestly assess own performance upon completion of engagements or assignments. Solicit overall performance feedback on assigned areas from in-charge employees. Seek additional responsibilities on engagements that you feel you would like to be given the opportunity to undertake and will help enhance your career and knowledge. Gain understanding of department goals and responsibilities. Take responsibility for attaining chargeable hour requirements. Participate in industry meetings and seminars. Be cognizant of interactions within the community, realizing that in many cases you may be the only source of exposure for YHB. Understanding the role of Manager and working to expand roles and responsibilities to that level. Overnight travel to out-of-town YHB offices, client locations and continuing professional education may be required. Leading and Developing Others Provide Associates with the framework to complete assignments based on experience levels. Develop ability to communicate review comments professionally while providing feedback, which will assist in the development of the person whose work was reviewed. Participate in the training, motivation, supervision, and evaluation of team members. Begin identifying opportunities to assist in course material preparation and/or instruction of in-house courses. Offer constructive feedback to Associates. Serve as the primary day-to-day contact for Associates; increase cooperation and success by being accessible and approachable to the feelings and perspectives of others. Demonstrate an understanding of the importance of cooperation and teamwork through daily interactions with co-workers and in-charge employees. Maintain positive working relationships with supervisors, clients, and other team members by displaying attitudes of helpfulness, a focus on team success, and the consideration of the ideas of others. Required Education and Experience Bachelor's degree in accounting or relevant field required. Requirements to achieve the CPA certification and/or other certifications of similar standing as approved for development. Possesses a high level of integrity and ability to respect confidentiality. Effective verbal and written communication skills Ability to handle multiple tasks simultaneously. Knowledgeable of firm policies and procedures Enthusiastic and self-motivated Demonstrated time and work management skills necessary to manage a complex workload. Benefits & Perks We believe that real effort should be rewarded. That is why YHB is investing in our people and fostering a supportive, rewarding work environment. As part of our team, you will enjoy: Competitive Compensation & Rewards: Market-competitive salary with performance-based bonuses. Retirement savings plan with a 401(k) & profit-sharing plan. Comprehensive Health & Wellness: Health, dental, and vision insurance. Wellness programs and employee assistance programs (EAP). Paid parental leave and family support. Professional Development: Learning and development opportunities. Tuition reimbursement. CPA exam support, certification reimbursements, and mentorship programs. Internal promotions and career pathing opportunities. Work-Life Balance: Generous paid time off (PTO) and holidays. Flexible work arrangements (hybrid/remote options available). Engaging Work Culture: Collaborative and inclusive work environment. Employee resource groups and diversity initiatives. Social events, team-building activities, and volunteer opportunities. YHB is strongly committed to providing equal employment opportunity for all employees and all applicants for employment. For us, this is the only acceptable way to do business! #LI-Remote #LI-Hybrid #LI-KB1

The SCC's Health Benefit Exchange division is seeking an experienced IT auditor to support our transition to a new security standard and strengthen our third -party risk management program. This role will help interpret and implement updated security requirements, conduct audits and assessments of both internal processes and external vendors and partners evaluating controls and recommending improvements. Responsibilities Include: Assess current security controls and processes against new CMS, IRS, and SCC security standards. Identify gaps and recommend remediation steps to achieve and maintain compliance. Plan, lead, and execute development and updates to policies, procedures, and documentation to reflect requirements. Design, implement, and train on the process for assessing partners and vendors, ensuring alignment with security standards. Develop assessment tools, workflows, and scoring model to evaluate and measure the effectiveness and compliance of vendor and partner security controls. Evaluate the security posture of vendors and partners to ensure information security contractual, information sharing, and data sharing agreement requirements are met. Test the effectiveness of operational and management controls using interviews, document reviews, and observation. Analyze, assess, report, and present on audit findings, risk exposure, and recommendations. Support information security continuous monitoring and incident response programs. Perform related work as required. On Site Required: Tuesday and Thursday each week Pls note: The manager will conduct first round interviews on TEAMS and then require the TOP candidate in for a follow up IN PERSON (2nd) interview.

Hiring Company: Boar's Head Provisions Co., Inc. A FSQ Auditing Specialist is the Lead SQF practitioner designated to oversee the development, implementation, review, and maintenance of the Plants Food Safety Quality Management System & to ensure the current level of certification is maintained. Lead the team in preparing for annual SQF recertification audits for Food Safety & CFS Sanitation Continuum. Facilitate annual review of FSQM Program and all supporting information including but not limited to verification & validations of all Standard Work Instructions. Maintain and assist in all updates to the current processes and work Instructions. The backup SQF Practitioner will be filled by the QA Mgmt. or designee. Job Description: Essential Duties and Responsibilities * Audit Quality Management System Program elements (i.e. SQF, POGs, Sanitation Continuum) leveraging TraceGains Audit Module. * Re-assess and re-validate associated Work Instructions and Process Operating Guides (POGs) with any implemented process or product change. * Manage and maintain all daily FSQ documents. * Lead & conduct annual review of plant FSQ Program and ensure associated Sub-Elements and registers are updated. * Lead annual 3rd Party GFSI re-certification audits and be available to support other Plant audits. * Work cross functionally with FSQA, HR, Process Systems, Sanitation, and Production personnel on any new changes to the Work Instructions. * Effectively communicate any changes, modifications, or updates to managers, supervisors, leads, and other personnel. * Facilitate Root Cause Investigations on Product &/or Process Concerns that may arise. * Lead Sanitation Continuum Assessments locally and support other Plants periodically throughout the year. * Lead HACCP Annual reassessments & validations. * Leveraging TraceGains, review, audit, approve FSQA related documents from ingredient, packaging & raw material suppliers. * Provide concise and effective feedback concerning issues. * Manage special projects or other duties as assigned. Education and Experience * BS degree in a Food Science is preferred with 5+ years of experience in Quality Assurance, Food Safety or a related field. A mixture of education and experience equivalent to the above may substitute. * Must be HACCP certified or able to attain within 3 months and possess a high level of HACCP knowledge. * Must be an SQF Certified Practitioner or able to attend training and become certified within 3 months. * Must be ASQ Certified or able to obtain an ASQ Certification (i.e. CFSQA) within 6 months. * Be able to attend & successfully complete Commercial Food Sanitation Training & Certification. * Have excellent oral and written communication skills. * Possess the ability to perform basic math, algebraic, and geometrical equations and formulas. Must be able to compute mathematical conversions. * Proficient in MS Office applications (i.e. Outlook, Excel, Teams) Additional Responsibilities * Quality Management System Training responsibilities (i.e. ETQ). * Assist with Quality Mapping of product concerns and trending issues within the plant. Language Skills * Fluency in the English language required & bilingual in Spanish preferred. * Must have excellent oral and written skills at a technical and general level. * Must be able to effectively communicate with all levels within both a manufacturing and corporate environment. Mathematical Skills * General math skills * Must be able to create, read, analyze process charts, graphs, and logs. * Must have a thorough understanding of statistical analysis. Reasoning Ability * Must possess sharpened analytical, logical and problem solving skills. Certificates, Licenses, and Registrations * Valid Driver's License * Must be HACCP certified or able to attend within 3 months and possess a high level of HACCP knowledge. * Must be an SQF Certified Practitioner or able to attend training and become certified within 3 months. * Must be ASQ Certified or able to obtain an ASQ Certification (i.e. CFSQA &/or CQA) within 6 months. Physical Demands * Must be able to lift overhead up to 30 pounds. * Must be able to stand and/or walk for extended periods of time. * Must possess sufficient senses to perform effective organoleptic evaluations (corrected sensory ability is acceptable). This includes visual (acuity and color differentiation), olfactory, gustatory, tactile, and auditory ability. Work Environment * Must be able to work in both warm and cold environments. * Must be able to travel to other BH Plants as needed. * Be able to travel up to 30%. Interpersonal Skills * Excellent verbal and written communication skills * An ability to communicate complex and technical issues to diverse audiences, orally and in writing, in an easily understood, authoritative, and actionable manner * Strong decision-making capabilities, with a proven ability to weigh the relative costs and benefits of potential actions and identify the most appropriate one * An ability to effectively influence others to modify their opinions, plans, or behaviors * An understanding of business needs and commitment to delivering high-quality, prompt, and efficient service to the business * An understanding of organizational mission, values, and goals * Excellent prioritization, time management and multi-tasking capabilities * Innovative thinker * Ability to deal with confidential information and matters * Adaptable and able to work well under pressure Location: Petersburg, VA Time Type: Full time Department: FSQA

Hiring Company: Boar's Head Provisions Co., Inc.Overview:A FSQ Auditing Specialist is the Lead SQF practitioner designated to oversee the development, implementation, review, and maintenance of the Plants Food Safety Quality Management System & to ensure the current level of certification is maintained. Lead the team in preparing for annual SQF recertification audits for Food Safety & CFS Sanitation Continuum. Facilitate annual review of FSQM Program and all supporting information including but not limited to verification & validations of all Standard Work Instructions. Maintain and assist in all updates to the current processes and work Instructions. The backup SQF Practitioner will be filled by the QA Mgmt. or designee.Job Description: Essential Duties and Responsibilities Audit Quality Management System Program elements (i.e. SQF, POGs, Sanitation Continuum) leveraging TraceGains Audit Module. Re-assess and re-validate associated Work Instructions and Process Operating Guides (POGs) with any implemented process or product change. Manage and maintain all daily FSQ documents. Lead & conduct annual review of plant FSQ Program and ensure associated Sub-Elements and registers are updated. Lead annual 3rd Party GFSI re-certification audits and be available to support other Plant audits. Work cross functionally with FSQA, HR, Process Systems, Sanitation, and Production personnel on any new changes to the Work Instructions. Effectively communicate any changes, modifications, or updates to managers, supervisors, leads, and other personnel. Facilitate Root Cause Investigations on Product &/or Process Concerns that may arise. Lead Sanitation Continuum Assessments locally and support other Plants periodically throughout the year. Lead HACCP Annual reassessments & validations. Leveraging TraceGains, review, audit, approve FSQA related documents from ingredient, packaging & raw material suppliers. Provide concise and effective feedback concerning issues. Manage special projects or other duties as assigned. Education and Experience BS degree in a Food Science is preferred with 5+ years of experience in Quality Assurance, Food Safety or a related field. A mixture of education and experience equivalent to the above may substitute. Must be HACCP certified or able to attain within 3 months and possess a high level of HACCP knowledge. Must be an SQF Certified Practitioner or able to attend training and become certified within 3 months. Must be ASQ Certified or able to obtain an ASQ Certification (i.e. CFSQA) within 6 months. Be able to attend & successfully complete Commercial Food Sanitation Training & Certification. Have excellent oral and written communication skills. Possess the ability to perform basic math, algebraic, and geometrical equations and formulas. Must be able to compute mathematical conversions. Proficient in MS Office applications (i.e. Outlook, Excel, Teams) Additional Responsibilities Quality Management System Training responsibilities (i.e. ETQ). Assist with Quality Mapping of product concerns and trending issues within the plant. Language Skills Fluency in the English language required & bilingual in Spanish preferred. Must have excellent oral and written skills at a technical and general level. Must be able to effectively communicate with all levels within both a manufacturing and corporate environment. Mathematical Skills General math skills Must be able to create, read, analyze process charts, graphs, and logs. Must have a thorough understanding of statistical analysis. Reasoning Ability Must possess sharpened analytical, logical and problem solving skills. Certificates, Licenses, and Registrations Valid Driver's License Must be HACCP certified or able to attend within 3 months and possess a high level of HACCP knowledge. Must be an SQF Certified Practitioner or able to attend training and become certified within 3 months. Must be ASQ Certified or able to obtain an ASQ Certification (i.e. CFSQA &/or CQA) within 6 months. Physical Demands Must be able to lift overhead up to 30 pounds. Must be able to stand and/or walk for extended periods of time. Must possess sufficient senses to perform effective organoleptic evaluations (corrected sensory ability is acceptable). This includes visual (acuity and color differentiation), olfactory, gustatory, tactile, and auditory ability. Work Environment Must be able to work in both warm and cold environments. Must be able to travel to other BH Plants as needed. Be able to travel up to 30%. Interpersonal Skills Excellent verbal and written communication skills An ability to communicate complex and technical issues to diverse audiences, orally and in writing, in an easily understood, authoritative, and actionable manner Strong decision-making capabilities, with a proven ability to weigh the relative costs and benefits of potential actions and identify the most appropriate one An ability to effectively influence others to modify their opinions, plans, or behaviors An understanding of business needs and commitment to delivering high-quality, prompt, and efficient service to the business An understanding of organizational mission, values, and goals Excellent prioritization, time management and multi-tasking capabilities Innovative thinker Ability to deal with confidential information and matters Adaptable and able to work well under pressure Location:Petersburg, VATime Type:Full time Department:FSQA

Be Part of an Extraordinary Team Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. Build the Possibilities. Make an Extraordinary Impact. Title: DRG Coding Auditor (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG) Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office. The DRG Coding Auditor is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending physician's statement sent in by acute care hospitals on submitted DRG. Primary duties may include, but are not limited to: * Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities. * Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. * Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters. * Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing). * Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and HACs. * Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations. Minimum Requirements: * Requires at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing. * Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder. * Requires 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. Preferred Skills, Capabilities and Experiences: * BA/BS preferred. * Experience with vendor based Diagnosis-Related Group (DRG) Coding/Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. * Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred. * Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $95,172 to $149,556. Location(s): Colorado; Illinois; Maryland; Minnesota; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Audit & Reimbursement III- Medicare Cost Report Audit Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement. They will participate in contractual Audit and Reimbursement workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain further experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities. How you will make an impact: * Analyzes and interprets data and makes recommendations for change based on judgment and experience. * Able to work independently on assignments and under minimal guidance from the manager. * Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements. * Gain experience with applicable Federal Laws, regulations, policies, and audit procedures. * Respond timely and accurately to customer inquiries. * Ability to multi-task while independently and effectively prioritizing work using time management, initiative, project management and problem-solving skills. * Must be able to perform all duties of lower-level positions as directed by management. * Participates in special projects and review of work done by auditors as assigned. * Assist in mentoring less experienced associates as assigned. * Perform complex cost report desk reviews. * Perform complex cost report audits, serving as an in-charge auditor assisting other auditors assigned to the audit. * Dependent upon experience, may perform supervisory review of work completed by other associates. * Analyze and interpret data per a provider's trial balance, financial statements, financial documents, or other related healthcare records. Minimum Requirements: * Requires a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an equivalent background. * This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years. Preferred Skills, Capabilities, and Experiences: * Degree in Accounting preferred. * Knowledge of CMS program regulations and cost report format preferred. * Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred. * MBA, CPA, or CIA preferred. * Must obtain Continuing Education Training requirements (where required). * A valid driver's license and the ability to travel may be required. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $61,560 to $102,060 Locations: Maryland, Minnesota, Nevada, and New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Title: Fiscal Compliance Auditor State Role Title: Auditor I Hiring Range: $69,000 - $75,286 Pay Band: 4 Recruitment Type: General Public - G Job Duties The Fiscal Compliance Auditor plans and conducts a variety of internal audits on VDH fiscal activities for federal pass thru entities. Characteristic activities include preparing draft audit reports of findings, making recommendations to management and following up to ensure that solutions are implemented. Assignments are well defined and require the application of existing principles, standards, policies, procedures, laws and federal compliance (CFR) regulations. Applies knowledge of applicable accounting, auditing, federal fiscal compliance, general business, and computer systems. Identifies program discrepancies and recommends solutions for review by State Office and local agency management. Responsible for tracking fiscal corrective action plans. Performs multiple program evaluations of internal control and compliance in accordance with applicable State and Federal regulations. Position interprets rules and regulations to perform assurance reviews that Federal money is spent correctly on program activities and in accordance with State fiscal policies. Provides policy and procedural interpretation to local agencies and State Office personnel within their assigned subject areas. Implements the Division's Process Plan for On-Site and Self-Conducted Auditing Reference Guide. This is a restricted position, which is solely funded by the Ryan White Care Act Title II grant. The agency receives this federal funding based on 5-year project periods, with annual budget periods of April 1 - March 31 for each of those 5 years. These funds are part of federal government appropriations. The availability of funding is reviewed annually. Continued employment is contingent on the continued availability of funds. The Virginia Department of Health offers 12 paid holidays, medical, dental, vision and life insurance, retirement plans (including 401a Cash Match and 457 Deferred Compensation Plan) as well as sick, family/personal, and annual leave! Minimum Qualifications Knowledge of generally accepted accounting and auditing principles and professional internal auditing standards. Knowledge and experience in Federal Fiscal Monitoring Standards for federal funding Demonstrated knowledge and ability to conduct a variety of external audits on fiscal activities Demonstrated ability to prepare audit reports of findings, make recommendations to management, and following up to ensure that solutions are implemented Demonstrated skills in monitoring, reviewing, and reporting of fiscal data on a routine basis Excellent written, oral, presentation, and communication skills Ability to research, compile, and analyze data Proficient skill in Microsoft Office Word, Excel, and PowerPoint Additional Considerations Knowledge of Ryan White grants' program and compliance responsibilities/requirements Experience serving as a compliance auditor/auditing experience. Ability to attend out of state meetings and conferences. Proficiency in use of tools for and knowledge about Federal Funding Accountability and Transparent Act (FFATA) reporting Special Instructions You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position. VDH accepts only on-line applications. Faxed, mailed, or e-mailed applications will not be considered. Applications are accepted until 11:55 p.m. on the job closing date. Applications and/or resumes should include relevant work history which indicates your qualifications for this position. Employment is contingent upon satisfactory results of a state and federal criminal history background check and the Department of Social Service's Child Abuse and Neglect Central Registry check, U.S. HHSIG Exclusion List check, employment reference check and E-Verify. Other financial, credit, driving, background checks or completion of Statement of Economic Interests may be required for certain positions. It is the policy of the Commonwealth and VDH that all aspects of human resource management be conducted without regard to race (or traits historically associated with race including hair texture, hair type, and protective hairstyles such as braids, locks, and twists); sex; color; national origin; religion; sexual orientation; gender identity or expression; age; veteran status; political affiliation; disability; genetic information; and pregnancy, childbirth, or related medical conditions. VDH employees have a shared Code of Ethics, which can be found in the bottom banner of our website: ********************* If you have been affected by DHRM Policy 1.30 layoff and possess a valid Interagency Placement Screening Form (Yellow Card) or a Preferential Hiring Form (Blue Card), you must submit the card before the closing date for this position. The Card may be submitted with the state application as an attachment. As a V3 (Virginia Values Veterans) employer VDH Welcomes Veterans to apply! Supplemental Questions: You may be required to respond to position-specific questions at the end of this application. This information will help us evaluate your credentials and qualifications for the job. Failure to respond to any questions may disqualify you from further consideration. Contact Information Name: Porsha Lewis Phone: N/A Email: ***************************** In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at ************. Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

You chart the course; we help you lift off. At YHB, we aren't limited by small-firm constraints or stuck in the big-firm mentality. Our culture is based on relationships between our teams and our clients. We aim to hire great people who want to take ownership of their careers while we help to provide the tools for success. Assurance Supervisors are responsible for the completion of various aspects of assurance engagements that have been assigned to them while developing subject matter expertise. They will begin to lead teams in understanding new assurance and accounting developments. They will take responsibility for the supervision and review of Associates' workpapers prior to Manager review. Roles and Responsibilities Technical Expertise and Work Quality Demonstrate a working knowledge of the technical aspects and issues related to their functional and industry specialization. Follow YHB guidance regarding secure use of hardware, software, and client information. Hold Associates accountable for protecting YHB assets and information. Maintain proficiency and identify efficiency with relevant firm technical resources and computer applications. Demonstrate effective use of these resources and use file and workpaper organization techniques. Continually strive to develop and maintain a high level of technical competence. Be capable of drafting professional correspondence to clients and superiors on complex subject matter. Draft formal communications that contribute to the planning and completion of the assurance engagement. Prepare workpapers that are neat, organized, and cross-referenced. Review workpapers prepared by Associates for accuracy, content, reasonable procedures, and supportable conclusions. Assign Assurance sections for Associates, allowing you to complete more technical and challenging Assurance sections. Complete assignments on time and within budget. Assign review comments to Associates on the engagements and verify the review comments have been appropriately addressed. Address review comments from the Manager and/or Principal. Provide input in the planning aspects of the engagement to improve quality and efficiency. Assist in preparation of current file and financial reporting requirements, if applicable to the engagement. Evaluate engagement performance and formalize suggestions for improvement of next year's engagement. Communicate with team members on job responsibilities (i.e., equipment responsibilities, dress code, and basic understanding of client) prior to arrival. Client Management and Service Maintain the complete confidentiality of firm and client information. Demonstrate an ability to work under time constraints; provide as much flexibility as possible when needed to meet client expectations and deadlines. Present yourself and your work product to clients and co-workers in a professional manner. Demonstrate working knowledge of clients' business needs by identifying issues and discussing resolutions with in-charge employees and implementing resolutions throughout the engagement process. Keep Managers, Principals, and Client Management informed of the engagement progress and issues as they develop. Develop and maintain strong, positive client relationships through timely communication during the engagement as well as periodic communication throughout the year. A commitment to respond to clients within 24 hours. Maintain daily time entry for accurate reporting firm wide. Business Development Recognize that practice expansion comes from existing clients as well as potential clients. Actively develop own referral network, recognizing that every interpersonal encounter may provide a business development opportunity. Participate in civic/professional organizations, as well as YHB marketing activities. Continue to gain an understanding of service capabilities. Develop a network of contacts and seek ways to increase firm visibility. Represent YHB publicly by accepting speaking opportunities, authoring articles for industry literature, YHB newsletters, etc. Personal Participation and Professional Development Assume responsibility for career growth by preparing personal development plans, tracking personal marketing activities, new business generation, identification of continuing education strategies, etc. Accept constructive input from and offer constructive feedback to Managers and Principals. Honestly assess own performance upon completion of engagements or assignments. Solicit overall performance feedback on assigned areas from in-charge employees. Seek additional responsibilities on engagements that you feel you would like to be given the opportunity to undertake and will help enhance your career and knowledge. Gain understanding of department goals and responsibilities. Take responsibility for attaining chargeable hour requirements. Participate in industry meetings and seminars. Be cognizant of interactions within the community, realizing that in many cases you may be the only source of exposure for YHB. Understanding the role of Manager and working to expand roles and responsibilities to that level. Overnight travel to out-of-town YHB offices, client locations and continuing professional education may be required. Leading and Developing Others Provide Associates with the framework to complete assignments based on experience levels. Develop ability to communicate review comments professionally while providing feedback, which will assist in the development of the person whose work was reviewed. Participate in the training, motivation, supervision, and evaluation of team members. Begin identifying opportunities to assist in course material preparation and/or instruction of in-house courses. Offer constructive feedback to Associates. Serve as the primary day-to-day contact for Associates; increase cooperation and success by being accessible and approachable to the feelings and perspectives of others. Demonstrate an understanding of the importance of cooperation and teamwork through daily interactions with co-workers and in-charge employees. Maintain positive working relationships with supervisors, clients, and other team members by displaying attitudes of helpfulness, a focus on team success, and the consideration of the ideas of others. Required Education and Experience Bachelor's degree in accounting or relevant field required. Requirements to achieve the CPA certification and/or other certifications of similar standing as approved for development. Possesses a high level of integrity and ability to respect confidentiality. Effective verbal and written communication skills Ability to handle multiple tasks simultaneously. Knowledgeable of firm policies and procedures Enthusiastic and self-motivated Demonstrated time and work management skills necessary to manage a complex workload. Benefits & Perks We believe that real effort should be rewarded. That is why YHB is investing in our people and fostering a supportive, rewarding work environment. As part of our team, you will enjoy: Competitive Compensation & Rewards: Market-competitive salary with performance-based bonuses. Retirement savings plan with a 401(k) & profit-sharing plan. Comprehensive Health & Wellness: Health, dental, and vision insurance. Wellness programs and employee assistance programs (EAP). Paid parental leave and family support. Professional Development: Learning and development opportunities. Tuition reimbursement. CPA exam support, certification reimbursements, and mentorship programs. Internal promotions and career pathing opportunities. Work-Life Balance: Generous paid time off (PTO) and holidays. Flexible work arrangements (hybrid/remote options available). Engaging Work Culture: Collaborative and inclusive work environment. Employee resource groups and diversity initiatives. Social events, team-building activities, and volunteer opportunities. YHB is strongly committed to providing equal employment opportunity for all employees and all applicants for employment. For us, this is the only acceptable way to do business!

Audit & Reimbursement III Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. * Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement. They will participate in contractual Audit and Reimbursement workload, and have opportunities to participate on special projects. This position provides a valuable opportunity to gain further experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities. How you will make an impact: * Analyzes and interprets data and makes recommendations for change based on judgment and experience. * Able to work independently on assignments and under minimal guidance from the manager. * Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements. * Gain experience with applicable Federal Laws, regulations, policies and audit procedures. * Respond timely and accurately to customer inquiries. * Ability to multi-task while independently and effectively prioritizing work using time management, initiative, project management and problem-solving skills. * Must be able to perform all duties of lower-level positions as directed by management. * Participates in special projects and review of work done by auditors as assigned. * Assist in mentoring less experienced associates as assigned. Job specific functions for Reopening Team: * Review Medicare cost report re-openings initiated from provider requests, CMS requests, or by the MAC * Perform level 1 or level 2 audit review as part of the reopening process on all areas of the Medicare cost report such as Medicare DSH, Bad Debts, IME/DGME, NAH, Organ Acquisition and all cost based principles * Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other related healthcare records * Actively participate in development of Audit & Reimbursement standard operating procedures * Activity participate in workgroup initiatives to enhance quality, efficiency and training Minimum Requirements: * Requires a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an equivalent background. * This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years. Preferred Skills, Capabilities and Experiences: * Degree in Accounting or Finance preferred. * Knowledge of CMS program regulations and cost report format preferred. * Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred. * MBA, CPA or CIA preferred. * Must obtain Continuing Education Training requirements (where required). * A valid driver's license and the ability to travel may be required. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $61,560 to $102,060 Locations: Maryland, Minnesota, Nevada, and New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

**_Virtual: _** _ _ This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered. + _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending physician's statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding principles (found in the Official Coding Guidelines, Coding Clinics, and the ICD-10 Alphabetic and Tabular Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities. + Draws on extremely advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate sophisticated conclusions. + Utilizes audit tools and auditing workflow systems and reference information to make audit determinations and generate audit findings letters. + Validates accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation purposes (e.g., letter writing) on lower level auditors. + Identifies new claim types by identifying potential claims outside of the concept where additional recoveries may be available, such as re-admissions, Inpatient to Outpatient, and Hospital Acquired Conditions (HACs), Preventable Adverse Events (PAEs) or Never Events. + Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations. + Operates largely independently and autonomously with little oversight due to extremely high quality output and audit results that only the most advanced and experienced DRG Coding Auditors would understand. + Performs secondary audits on claims that have been reviewed by other DRG Coders for missed opportunities and identifies gaps in foundational audit knowledge. + Collaborates with management to improve selection criteria. **Minimum Requirements:** + Requires at least one of the following: AA/AS or minimum of 15 years of experience in claims auditing, quality assurance, or recovery auditing. + Requires at least one of the following certifications: RHIA certification as a Registered Health Information Administrator, RHIT certification as a Registered Health Information Technician, CCS as a Certified Coding Specialist, CIC as a Certified Inpatient Coder, or Certified Clinical Documentation Specialist (CCDS). + Requires minimum of 10 years experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. **Preferred Skills, Capabilities and Experiences** : + BA/BS preferred. + Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $119,760 to $206,586 Locations: California; Illinois; Minnesota; New Jersey; In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.