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  • Financial Examiner - EIC

    Rsm 4.4company rating

    Remote bank examiner job

    We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM. Financial Examiner, Examiner-In-Charge (EIC) Risk & Regulatory Consulting, LLC (Regulatory Insurance) Work from home-any US location Position Overview The Financial Examiner, EIC will primarily perform financial examinations and regulatory consulting services for state insurance departments. This position has significant opportunity for advancement as well as personal and professional growth. Specific Duties and Responsibilities Perform risk focused financial examinations to determine solvency and compliance to statutes on behalf of Risk & Regulatory Consulting LLC insurance clients. Perform reviews of examination work papers and evaluate insurance company operations. Serve as Examiner-In-Charge on examinations of significant size and complexity Ensure the integrity of the regulatory system. Assist with the preparation of reports, exhibits, and other supporting schedules that detail a company's solvency, condition and compliance with laws and regulations, and recommend solutions to questionable financial conditions. Responsible for timely submission of draft reports for review. Recommend/document actions to ensure compliance with laws and regulations, or to protect solvency of the company. Provide knowledge and guidance of insurance laws, rules, and regulations. Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to interpret their meaning and determine impact to the company. Analyze financial operating statements, reports, and records relating to specific and overall operations of insurance companies; prepare and supervise writing of clear, complete, concise, and informative reports of financial conditions of insurance companies and health care organizations. Consistently enhance knowledge of: principles, practices, techniques, and methods of accounting and auditing; insurance examination and regulation; insurance laws and Insurance Commissioner's rulings; and related Attorney General opinions and court decisions; insurance company practices; statistical sampling procedures; basic actuarial mathematics; principles and practice of effective supervision, insurance companies and health care organizations. Requirements Bachelor's Degree in Accounting or Finance; MBA and/or professional certification/s preferred Minimum 10+ years' experience as a financial examiner serving as EIC on exams of significant size and complexity. Insurance industry experience is a must. Certified Financial Examiner (CFE) is a must, CPA or CPA candidate, and/or Certified Internal Auditor (CIA) or CIA Candidate a plus PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point) Strong interpersonal, presentation, analytical and examination/audit skills Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills Strong written and verbal communication skills are required Dynamic/flexible demeanor with exceptional client service skills Must be self-motivated, work well independently and possess a sense of urgency Skilled in team building and team development Work from home with flexibility to travel Ability to demonstrate ethical and professional standards as outlined by the Firm Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed. RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients. Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients. RRC is managed by eight partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES. At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at ************************************************** All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at ************ or send us an email at *****************. RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate. RSM will consider for employment qualified applicants with arrest or conviction records in accordance with the requirements of applicable law, including but not limited to, the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance for Employers, and the San Francisco Fair Chance Ordinance. For additional information regarding RSM's background check process, including information about job duties that necessitate the use of one or more types of background checks, click here. At RSM, an employee's pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range. Compensation Range: $94,400 - $178,800 Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance.
    $94.4k-178.8k yearly Auto-Apply 60d+ ago
  • TDI-Financial Examiner III

    Capps

    Remote bank examiner job

    TDI-Financial Examiner III (00051321) Organization: TEXAS DEPARTMENT OF INSURANCE Primary Location: Texas-Travis Work Locations: Home Office - Travis County (454-HO-227) Travis County Travis Job: Business and Financial Operations Employee Status: Regular Schedule: Full-time Standard Hours Per Week: 40.00 Travel: Yes, 75 % of the Time State Job Code: 1104 Salary Admin Plan: B Grade: 21 Salary (Pay Basis): 6,016.89 - 6,016.89 (Monthly) Number of Openings: 3 Overtime Status: Non-exempt Job Posting: Oct 28, 2025, 11:52:50 AM Closing Date: Ongoing Description Do you have a passion for public state service and enjoy making a difference? Don't miss out on this opportunity. The Texas Department of Insurance (TDI) is hiring! Apply today if you're looking for a rewarding career in public state service. TDI regulates the insurance industry, administers the Texas workers' compensation system, educates, and protects consumers. TDI is located at the Barbara Jordan Building at 1601 Congress Avenue in Austin, near the Texas Capitol. Benefits of working at TDI: · Flexible work schedules. · Work-life-balance. · 96 hours of accrued vacation a year. · 96 hours of accrued sick leave a year. · 20+ holidays every year. · Career advancement opportunities. · Free parking. · 401(k) and 457 Programs. · State of Texas retirement plan with a lifetime annuity through the Employee Retirement System of Texas (ERS). · Free comprehensive medical insurance for full-time employees and 50% off premium costs for dependents (state pays other 50%). · Optional benefits like dental, vision, life insurance, and many more. · Qualified employer for the Federal Public Service Loan Forgiveness Program. Before you apply: Learn about our selection process, our military employment preference, licensing, and credential requirements. Financial Examiner III (Financial Examiner Trainee) Austin Area Financial Solvency Examinations evaluates the financial condition of insurance companies to determine their ability to pay claims and ensure compliance with state insurance laws. This position performs moderately complex (journey-level) financial examination work. Work involves reviewing, testing, and evaluating fiscal, corporate, and operational records, and conducting examinations to determine and report on financial conditions and compliance with statutory requirements, bylaws, and rules. Works under general supervision, with limited latitude for the use of initiative and independent judgment. This position: · Assists with risk identification and risk mitigation and effect on financial solvency. · Evaluates reported assets, liabilities, and capital and surplus for compliance with statutes, rules, and regulations. · Reconciles company records and workpapers to annual and other financial statements; prepares worksheets and calculations of financial data from company records. · Identifies and reports on examination findings related to financial solvency or statutory compliance. · Actively participates in self-study regime to meet examiner certification and training requirements. · Provides assistance in meetings with executive and/or senior level management of companies to discuss risks, financial data, and policies and procedures. · Assists with special projects and performs other duties as assigned. Qualifications This position requires: Graduation from an accredited four-year college or university with major coursework in business administration, accounting or finance, risk management, economics, or a related field. Successful completion of the following courses is required for degrees other than Accounting: Accounting Fundamentals (6 semester hours) Finance or Economics (3 semester hours) General Auditing (3 semester hours) Business Law (3 semester hours) Or Have a Master of Science (MS) or Master of Business Administration (MBA) in accounting from an accredited college or university. Or Be a Certified Public Accountant. Candidates must submit transcripts from all academic institutions where course credit was earned. Applications without complete transcripts will not be considered. Note: Must be eligible for the bond-related provisions of Insurance Code Section 401.106 and take the oath required by Insurance Code Section 401.105. Additional job details: This is a remote work position that requires extensive travel (up to 75%). No office will be provided by the department. Candidates must have a secure, dedicated workspace with Internet service. Must be available during approved work schedule for meetings and group collaboration via Microsoft Teams and other applications. Must attain the Accredited Financial Examiner (AFE) designation from the Society of Financial Examiners within a period of no longer than three years after employment. Must attain the Certified Financial Examiner (CFE) designation from the Society of Financial Examiners within a period of no longer than five years after employment. Preferences for this position include: · Experience with regulatory examinations or related audits. · Demonstrated understanding of general insurance terminology. · Experience with statutory accounting principles. · Demonstrated ability to identify and assess risk. This position requires demonstrated knowledge of: · Basic auditing and accounting standards of Statutory Accounting Principles (SAP) and Generally Accepted Accounting Principles (GAAP). · General office practices and administrative procedures. · General understanding of business law and practices. · Gathering and assimilating information from multiple sources efficiently. · Developing clear and concise conclusions. · This position requires demonstrated skill in: · Operating a motor vehicle in a safe and courteous manner in compliance with traffic laws. · Problem solving, decision making, and planning. · Gathering and assimilating information from multiple sources efficiently and developing clear and concise conclusions. · Organization and prioritization of tasks. · Using personal computers, including Microsoft applications (e.g. Word and Excel). This position requires the demonstrated ability to: · Satisfy the requirements to maintain fully qualified driving status. · Apply critical thinking to analyze and solve work problems and analyze and evaluate compliance trends. · Communicate professionally and effectively, both verbally and in writing, with all levels of employees and the general public. · Learn examination techniques, identify and assess risk and evaluate its effect on financial statements and related documents. · Apply statutory accounting practices and analytical skills. · Establish and maintain effective working relationships with management, team members, coworkers and public. · Take initiative, accept new challenges, and be adaptive to changes. · Manage time effectively to complete assigned items within the budgeted amount of time. Military Employment Preference Get help translating your military work experience and training courses into civilian job terms, qualifications/requirements, and skill sets. Redact personal or sensitive information from all attachments. To receive a military employment preference, you must submit the following documents, as applicable, with your application. See How to Apply - Military Employment PreferencApplicable Military Occupational Specialty (MOS) codes are included, but not limited to one of the following: 36A, F&S, 3404, 6FOX1, 65FX Click or copy and paste the following link into your browser to access Military Crosswalk information: ************************************************************************************************ How to apply: All applications must contain complete job histories, including job title, dates of employment, name of employer, manager's name and phone number, and a description of duties performed. We may reject applications that do not include all the required information. Resumes do not substitute for this required information. Submitted through Work in Texas: Work in Texas (WIT) applicants must complete supplemental questions to be considered for the position. To complete supplemental questions, go to CAPPS Career Center to register or log in and access your profile.
    $56k-84k yearly est. Auto-Apply 4h ago
  • Senior Triage Examiner

    Insurance Company of The West

    Remote bank examiner job

    Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The purpose of this job is to manage new Workers' Compensation losses for the first 10 days of the life of the claim. This job takes necessary steps to assess and summarize new losses, prepare an action plan, set diaries, and reserve the file, all in preparation for assigning the file to an examiner for permanent handling. ESSENTIAL DUTIES AND RESPONIBILITIES Administers benefits to injured workers in accordance with statutory and case law as well as pertinent regulations for the first 10 days of the claim. Represents the Workers' Compensation Department and ICW Group when interacting with injured workers. Communicates with insureds to obtain information necessary for processing claims. Contacts and/or interviews injured workers, doctors, medical specialists, attorneys, and employers to get additional information. Communicates claim activity and processing with the injured worker and insured. Maintains professional client relationships. Communicates effectively with other Company departments. Creates reserves in a timely manner to ensure reserving activities are consistent with company standards and best practices guidelines. Manages complex claims and approves payment of benefits within higher designated authority level. Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. Prepares an action plan and set diaries, in preparation for assigning the file to an examiner for permanent handling. Assists with special projects and development of more junior team members as needed. SUPERVISORY RESPONSIBILITIES This role does not have supervisory responsibilities but may mentor and/or train junior team members. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum of 2-3 years of insurance or claims related experience, or equivalent combination of education and experience required. Minimum 1-2 years of workers' compensation claims experience required. CERTIFICATES, LICENSES, REGISTRATIONS California Only : All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required. California Only: California Workers' Compensation Claims Administration (WCCA) and Workers' Compensation Claim Professional (WCCP) certifications preferred. All other jurisdictions: State Workers' Compensation License as required. KNOWLEDGE AND SKILLS Understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written communication skills, time management and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Able to resolve conflicts fairly and equitably. Problem solving and decision-making ability, PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $61,979.26 - $97,736.56 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? • Challenging work and the ability to make a difference • You will have a voice and feel a sense of belonging • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match • Bonus potential for all positions • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) • 11 paid holidays throughout the calendar year • Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims
    $62k-97.7k yearly Auto-Apply 9d ago
  • Auditor, Audit and Compliance (Remote)

    Abbvie 4.7company rating

    Remote bank examiner job

    AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas - immunology, oncology, neuroscience, and eye care - and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at ************** . Follow @abbvie on X , Facebook , Instagram , YouTube , LinkedIn and Tik Tok . Job Description The function of Audit and Compliance Auditor is to performs comprehensive audits for compliance with US and foreign regulation requirements, providing constructive evaluation of quality related systems for AbbVie plants, affiliates, quality service areas and/or suppliers that provide materials, services, and products to AbbVie. Their execution in the area of GMP compliance and quality assures that activities are performed and documented in accordance with AbbVie policies/procedures and applicable quality and regulatory requirements intended to assure the quality, effectiveness, and safety of our products. This position serves a tactical purpose for AbbVie and must achieve a difficult balance of involvement and objectivity. Responsibilities : 75% Travel Assesses compliance of systems, facilities, and procedures per applicable regulations, assuring compliance to regulatory requirements and AbbVie specifications. Provides feedback in the form of audit observations and reviews corrective actions to determine if commitments have been properly implemented, are proven to be effective, and are being maintained at the supplier or internal AbbVie site. For internal sites, formulates recommendations for corrective actions. Participates in strategic initiatives to improve compliance to regulatory requirements and standards. Collaborates with R&D QA to coordinate and conduct joint audits. Communicates and coordinates supplier audit activities with internal stakeholders such as procurement, SQA, EQA, manufacturing sites and commercial affiliates as well as external stakeholders Ensures audits are conducted according to the annual audit schedule. Ensures no product launch delays or business interruptions due to supplier audit delays thereby assuring supply to AbbVie patients. Qualifications Bachelor's Degree preferably in technical or scientific area (Chemistry, Pharmacy, Biology, Microbiology, or Engineering) or equivalent industry experience (at least 4 years) with sufficient exposure to pharmaceutical, medical device, biologics and combination products, cosmetics, eye care or aesthetics related industries. ASQ certification desired. 6+ years of total relevant experience, including 4+ years in Quality Assurance with some project management experience in the pharmaceutical, medical device, biotechnology or related industry and 2+ years in compliance/auditing is required. Must have a technical background, including an understanding of Quality Assurance audit process and knowledge of worldwide requirements related to GMP regulations for quality systems and compliance. Must understand a variety of quality/operational systems that support facility, product design, development, production, distribution, installation, support, and service and understand the principles of quality management Excellent oral/written communications skills. Must exhibit strong interpersonal skills, tact, open mindedness, maturity, tenacity, self-reliance, organizational/administrative skills, and sound judgment. Must be able to effectively communicate and influence others outside of the company as well as internal stakeholders across functional and technical areas Please note: The grading and compensation of this role may vary depending on location. Additional Information Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range. This range may be modified in the future. We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical/dental/vision insurance and 401(k) to eligible employees. This job is eligible to participate in our short-term incentive programs. This job is eligible to participate in our long-term incentive programs Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company's sole and absolute discretion, consistent with applicable law. AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community. Equal Opportunity Employer/Veterans/Disabled. US & Puerto Rico only - to learn more, visit ************************************************************************* US & Puerto Rico applicants seeking a reasonable accommodation, click here to learn more: *************************************************************
    $96k-123k yearly est. 9h ago
  • BSA/AML/OFAC Compliance Auditor III

    Pathward, N.A

    Remote bank examiner job

    We are a hybrid, remote-office company dedicated to growing our talent anywhere! We have onsite locations in: Sioux Falls, SD, Scottsdale, AZ, Louisville, KY, Troy, MI, Franklin, TN, Easton, PA. At Pathward, we take tremendous pride in our purpose to create financial inclusion for all™. We are a financial empowerment company that works with innovators to increase financial availability, choice, and opportunity for all. We strive to remove barriers that traditional institutions put in the way of financial access, and promote economic mobility by providing responsible, secure, high quality financial products. We are a team of problem solvers and innovators who celebrate our differences and know that our unique perspectives make us stronger and well-positioned for success. We celebrate, and embrace, our team members through our *HUMBLE*HUNGRY*SMART approach, and we believe that we are strongest when we embrace the voices of our employees, customers, partners, and the communities we serve. About the Role: Independently plans and executes complex, risk‑based audits with a primary focus on BSA/AML, sanctions (OFAC), and Partner Solutions (embedded finance/“BaaS”). The role applies deep financial‑crimes and partner‑oversight expertise to assess governance, risk management, and control effectiveness across Pathward's products, services, and third‑party ecosystems. Leveraging sound judgment, data‑driven analysis, and plain‑language storytelling, this position develops actionable insights, influences senior stakeholders, and drives continuous improvement, while adhering to the IIA Standards and Pathward's Internal Audit methodology, and expectations from regulatory bodies such as the OCC and FinCEN. While the core emphasis is on financial‑crimes and partner‑banking risks, this position will also lead audits in adjacent domains (e.g., operations, payments and money movement, consumer compliance) as business needs dictate. The ideal candidate thrives in ambiguity, navigates complex business models and technology stacks, and communicates with clarity and empathy to build trust and deliver high‑quality outcomes. Experience engaging with regulatory bodies is highly valued. What You Will Do: Plan and lead end‑to‑end, risk‑based audits (planning, fieldwork, reporting, and follow‑up). Set clear objectives/scope/criteria; identify key risks and controls; tailor procedures to business model and risk profile; deliver on time with high quality. Evaluate BSA/AML program pillars, governance and oversight, risk assessments, internal controls, policies and standards, training, and monitoring/quality assurance. Test financial‑crimes processes: CIP/KYC/CDD/EDD, customer risk rating, watchlist screening, transaction monitoring, investigations, SAR/CTR obligations, model validation and coverage, and recordkeeping across platforms and partners. Assess sanctions (OFAC) compliance: governance, interdiction, alert handling, escalation, and intersections across payments and money‑movement rails. Audit Partner Solutions (BaaS) and related third-party oversight including BSA/AML and OFAC compliance across the partner lifecycle: due diligence, onboarding, ongoing monitoring, change management, issue management, and termination. Review BSA/AML and OFAC third-party risk classification, oversight practices, and compliance reporting for sufficiency, accuracy, and decision usefulness. Use data analytics, where possible, to profile population risk, select samples, and detect anomalies across screening, monitoring, disputes, and partner portfolios. Evaluate enterprise interdependencies affecting BSA/AML and OFAC by testing data from source to report, testing ownership and SLAs at handoffs, and identifying gaps so processes are reliable, well‑controlled, and decision‑useful. Assess rules/models/scenarios and data pipelines: change control, documentation, performance monitoring/back‑testing, and data lineage/integrity supporting BSA/AML and OFAC. Produce clear, evidence‑based findings with root‑cause analysis, business impact, and prioritized action plans; challenge management responses and validate remediation (including regulatory items) for sustained effectiveness. Engage stakeholders constructively (business leaders, Compliance, Risk, Technology); present concise, executive‑ready narratives/visuals; escalate emerging risks promptly and tailor messaging to audiences (working groups, executives, committees). Lead non‑financial‑crimes audits as needed (e.g., payments and money movement (ACH/wires/RTP)), consumer compliance, third‑party risk management, and model risk-applying the same risk‑based methodology and clear, audience-tailored reporting. Coordinate co‑sourced providers, ensuring adherence to methodology, templates, workpaper quality, and delivery timelines. Support annual risk assessment and audit planning with insights on regulatory themes, partner risks, product/technology changes, and data/controls maturity. Exemplify ethics and judgment: integrity, objectivity, confidentiality, and sound judgment under uncertainty/complexity. Demonstrate strong interpersonal effectiveness: active listening, constructive feedback, patience and perseverance, collaborative relationships, compassion and respect, customer focus, and disciplined planning to achieve audit goals. Stay abreast of emerging issues involving internal audit, changes to federal and state banking laws, and evolving laws and regulations that could impact the organization, particularly with BSA/AML and sanctions, BaaS, third party risk, prepaid products and/or deposit products, consumer payment applications/wallets, and/or digital or electronic payments processing/processors. Assist in the development of less-experienced staff through the review of audit work papers and timely feedback. Other duties as assigned. What You Will Need: Bachelor's degree in a relevant field (e.g., Accounting, Finance, Business, or related displace), or equivalent education and work Professional certifications such as: CAMS, CFE, CIA, CRMA, and/or CPA preferred. Additional credentials in BSA/AML, or sanctions compliance are a plus. 5+ years of relevant experience in internal audit, compliance, or risk within financial services. Demonstrated strength in BSA/AML, sanctions, and partner/third‑party oversight. Ability to pivot and lead audits in adjacent domains. Proficiency with data‑centric testing and visualization techniques; strong written and verbal communication. The responsibilities listed above are not all inclusive and may be changed at any time. Salary range: $72,000 - $120,000 The salary range reflects the minimum and maximum target for a new hire in this role. Individual pay within the range will be determined by multiple factors which can include but are not limited to a candidate's experience, qualifications, skills, and location. Your recruiter can share more about the specific salary for your location during the hiring process. Ranges may be modified in the future. This role is also eligible for an annual performance-based incentive opportunity. Pathward offers a comprehensive benefits package for eligible employees, including health insurance, 401(k) retirement benefits, life insurance, disability benefits, paid time off, and more. #LI-Remote Don't have everything listed under qualifications? If you're excited about this role but your experiences don't match exactly to everything in the posting, we encourage you to apply anyway. You may be just the right candidate for this or other Pathward roles. Pathward is an equal employment opportunity employer and considers candidates for roles without regard to their race, sex, national origin, ethnicity, age, disability or any other category protected by law. Who we are: Our commitment to inclusion is woven into our DNA. We believe that we are strongest when we embrace the voices of our employees, customers, partners, and the communities we serve. We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, ethnicity, religion, sex, sexual orientation, gender identity, transgender status, pregnancy, national origin, age (age 40 and over), disability, genetic information, marital status, hair texture or hairstyle, ancestry, service in the uniformed services, protected veteran status, status as a victim of domestic violence or any other class protected by federal, state and local laws. Please click here to learn more about our benefits and review information about our Privacy Policy, Affirmative Action Plan and other notices. Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. For assistance completing an application, please contact a Pathward People & Culture Representative by emailing - ******************** Please click here to view Pathward's Applicant Privacy Notice. Applications will be accepted for a minimum of 3 days after posting, and there is no predetermined date by which applications should be submitted. Knowingly submitting false information will result in disqualification for consideration of future positions, termination of employment and forfeiture of other rights. Candidate Scam Warning We encourage you to be cautious of hiring scams that impersonate Pathward. Copy and paste the following URL into your browser to learn more: *********************************************************
    $72k-120k yearly Auto-Apply 60d+ ago
  • Staff Clinical Compliance Auditor

    Danaher 4.6company rating

    Remote bank examiner job

    Bring more to life. Are you ready to accelerate your potential and make a real difference within life sciences, diagnostics and biotechnology? Within Danaher the work our diagnostic businesses do saves lives-and we're all united by a shared commitment to innovate for tangible impact. You'll thrive in a culture of belonging where you and your unique viewpoint matter. And by harnessing Danaher's system of continuous improvement, you help turn ideas into impact - innovating at the speed of life. We're accelerating the development of cutting-edge diagnostics to solve some of the world's most pressing health challenges. Across our diagnostics operating companies we are driving innovation through partnerships with top academic institutions and leading players in biopharma and translational research. We're bringing the best minds together to accelerate innovation and unlock the full potential of the latest scientific advances. Together, we're expanding access to precision diagnostics for millions of people worldwide - and we're using our unmatched global scale and proven playbook to make it happen, from hospital labs to mobile clinics. By helping providers, patients, and families get faster, more precise diagnostic results, we're improving treatment options and saving lives. Learn about the Danaher Business System which makes everything possible. This position is part of the Danaher Diagnostics organization and is a remote role. At Danaher Diagnostics, our vision is to be the leading provider of seamlessly connected diagnostic solutions. The Staff Clinical Compliance Auditor (Global Focus - Remote) for Danaher Diagnostics is responsible for clinical quality and compliance. This includes study audit and inspection management activities across the Clinical Center of Excellence (CCOE). You will be a part of the Clinical Compliance team and report to the Sr. Director of Global Clinical Compliance responsible for clinical quality and scientific writing to support new product research across four diagnostic operating companies within Danaher Diagnostics. If you thrive in a fast-paced, high impact role and want to work to build a world-class audit-ready Clinical organization-read on. In this role, you will have the opportunity to: Plan and execute internal audits of clinical trials, sites, vendors, and systems, and support external audits or regulatory inspections. Lead a comprehensive schedule of audits to ensure Bioresearch Monitoring (BIMO) inspection and notified body (NB) audit readiness. Lead the investigation of clinical quality issues, deviations, and non-conformances, managing the CAPA process to ensure effective resolution. Provide expert guidance and training to clinical study teams and other relevant staff on compliance requirements, best practices, and the clinical QMS. Monitor changes in relevant regulations and guidelines, assessing their impact on clinical operations and updating internal procedures accordingly. The essential requirements of the job include: Bachelor's degree with 6+ years clinical quality experience within diagnostics or medical device industry, or Master's or Doctoral degree with 4 years of the same experience. 4 years of clinical quality auditing experience or a combination of clinical project auditing and clinical study experience. In depth understanding of ISO 14155, 13485, 14971, 20916, in vitro diagnostic regulation (IVDR), medical device regulation (MDR), and pertinent sections of 21 CFR. Highly motivated to work in a fast-paced environment with effective use of prioritization, organization, problem-solving and time management skills. It would be a plus if you also possess previous experience in: Certified auditor (e.g., ASQ CQA or ASQ CBA, GCP) The technology and assays related to in vitro Diagnostic (IVD) across one or more of the following areas: chemistry, immunoassay, hematology, microbiology, or flow cytometry. Danaher Diagnostics, a Danaher company, offers a broad array of comprehensive, competitive benefit programs that add value to our lives. Whether it's a health care program or paid time off, our programs contribute to life beyond the job. Check out our benefits at danaherbenefitsinfo.com. Within Danaher Diagnostics we believe in designing a better, more sustainable workforce. We recognize the benefits of flexible, remote working arrangements for eligible roles and are committed to providing enriching careers, no matter the work arrangement. This position is eligible for a remote work arrangement in which you can work remotely from your home. Additional information about this remote work arrangement will be provided by your interview team. Explore the flexibility and challenge that working within Danaher Diagnostics can provide. The annual salary range OR the hourly range for this role is $115K-$135K. This is the range that we in good faith believe is the range of possible compensation for this role at the time of this posting. This range may be modified in the future. This job is also eligible for bonus/incentive pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance and 401(k) to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. 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. Join our winning team today. Together, we'll accelerate the real-life impact of tomorrow's science and technology. We partner with customers across the globe to help them solve their most complex challenges, architecting solutions that bring the power of science to life. For more information, visit **************** Danaher Corporation and all Danaher Companies are committed to equal opportunity regardless of race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The U.S. EEO posters are available here. We comply with federal and state disability laws and make reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact:************** or applyassistance@danaher.com.
    $115k-135k yearly Auto-Apply 60d+ ago
  • Global Trade Compliance Auditor

    Harman Becker Automotive Systems Inc. 4.8company rating

    Remote bank examiner job

    A Career at HARMAN As a technology leader that is rapidly on the move, HARMAN is filled with people who are focused on making life better. Innovation, inclusivity and teamwork are a part of our DNA. When you add that to the challenges we take on and solve together, you'll discover that at HARMAN you can grow, make a difference and be proud of the work you do every day. Introduction: A Career at HARMAN Corporate We're a global, multi-disciplinary team that's putting the innovative power of technology to work and transforming tomorrow. At HARMAN Corporate, you are integral to our company's award-winning success. Enrich your managerial and organizational talents - from finance, quality, and supply chain to human resources, IT, sales, and strategy Augment your comprehensive skillset with expert training across decision-making, change management, leadership, and business development Obtain 360-degree support throughout your career life cycle, from early-stage to seasoned leader About the Role The Trade Compliance Auditor is responsible for auditing customs-related import and export compliance within the United States, Canada and EMEA regions. This role serves to audit all compliance-related functions in the regions. This role reports to the Audit Manager, Trade Compliance. You will create and maintain trade compliance procedures and requirements to support the growth from an audit perspective. What You Will Do Responsible for executing against the auditing standards and performance criteria, managing audits. Complete an initial risk assessment of the regional trade compliance operation. Create both a line level audit review and more strategic “deep dive” audit plan. Create a comprehensive audit plan that feeds into the Global Trade Compliance audit strategy. Create regional KPIs based on audit results. Work closely with the Trade Compliance Operations team to communicate findings and follow through until sufficient risk is mitigated. Present regional audit results. Audit to ensure proper customs valuation, classification, country of origin. Planning, scheduling, coordinating, reviewing and reporting on compliance metrics within the trade compliance value chain. Ensure that local risk management frameworks and processes are aligned with global ones and address risks. Work closely within the audit team to ensure cohesiveness across all audit regions. Monitor and audit of regional import and export processes and documentation to ensure compliance with trade laws. Test processes for adherence to Harman's Trade Compliance Policy, manuals and internal procedures. Prepare audit reports & gap analysis, proposed remediation measures and targeted training to foster continuous improvement across the trade compliance value chain. Monitor to ensure Trade Compliance recordkeeping requirements are followed, including adherence to Standard Operating Procedures (SOP's). Identify and integrate ‘best practices' standards for the organization based on global cooperation. Build partnerships with third-party customs brokerage firms and trade compliance service providers. What You Need to Be Successful Bachelor's degree in Trade Compliance or related field. Experience in auditing trade-related functions preferred. 7+ years of experience in Trade Compliance operations. Global/multinational mindset and awareness. Areas of Expertise: Customs compliance; export/import activities; documentation; HTS classification. Experience with US, CA, and EMEA compliance operation Bonus Points if You Have Customs Broker License (LCB) or Certified Customs Specialist (CCS) credentials Experience with Thomson Reuters OneSource or similar global trade management (GTM) software Expertise with automotive parts and consumer electronics commodities is a plus Multi-cultural awareness and ability to adjust communication accordingly. What Makes You Eligible Be willing to travel up to 10% domestic and international travel. Be willing to work in an hybrid office environment and/or fully remote, with occasional trips into the office required. What We Offer Flexible work environment, allowing for full-time remote work globally for positions that can be performed outside a HARMAN or customer location Access to employee discounts on world-class Harman and Samsung products (JBL, HARMAN Kardon, AKG, etc.) Extensive training opportunities through our own HARMAN University Competitive wellness benefits Tuition reimbursement “Be Brilliant” employee recognition and rewards program An inclusive and diverse work environment that fosters and encourages professional and personal development #LI-JS247 #LI-Remote Salary Ranges: $ 76,500 - $ 112,200 HARMAN is proud to be an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
    $76.5k-112.2k yearly Auto-Apply 15d ago
  • Compliance Coding Auditor

    Sharp Healthcare 4.5company rating

    Remote bank examiner job

    Hours: Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. *This is a remote position* What You Will Do The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits. Required Qualifications 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. Preferred Qualifications Other : Strong background in in ICD-10-CM/PCS coding, DRG coding and CPT coding classification. Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED Certified Health Care Compliance (CHC) - Compliance Certification Board -PREFERRED Other Qualification Requirements Bachelor's degree in Business, Healthcare Administration, or related field - required. In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered. One of the following is required: AHIMA's Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification. Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Essential Functions Coding Compliance Compliance Coding and Billing Audits The Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary. Reviews the electronic health record to identify potential coding and billing compliance issues. Prepares written reports of audits, including recommendations to improve compliance. The Auditor will analyze and assess Sharp's potential risks using SHC's billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc. Policy and Procedure maintenance Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC's standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies. Professional development Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program. Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education. Unit support Key Stakeholder/Business Unit Support Responsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries. Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding. Maintain professional relationship with key stakeholders focusing on high level of client satisfaction. Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians. Professional competency Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Knowledge, Skills, and Abilities Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes. Computer proficiency with Microsoft office applications is required. Ability to function within a fast-paced, dynamic, and growing environment. Excellent time management and problem solving skills. Must demonstrate analytical ability, motivation, initiative, and resourcefulness. Teamwork and flexibility required. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
    $71.8 hourly Auto-Apply 60d+ ago
  • Experienced ABL Field Examiner

    LCG Advisors 4.2company rating

    Remote bank examiner job

    Job DescriptionSalary: LCG Advisors is looking for an Experienced ABL Field Examiner to work closely with our clients, including large money-center banks such as JP Morgan Chase, Bank of America, Goldman Sachs, and Regions Bank. Our client base includes private equity firms, financial intermediaries, family offices, and accredited investors. Finance jobs in Tampa with LCG offer a wide variety of benefits through a gratifying and rapidly evolving career. Primary Responsibilities: Conduct due diligence services, including audit engagements, portfolio reviews, and acquisition due diligence for a wide variety of clients Perform on-site or remote engagements as contracted by a bank or lender for clients needing lines of credit ranging from under one million dollars or as much as one billion dollars Conduct audits focused on the companys collateral typically accounts receivable and inventory - by understanding complex concepts or information Input examination findings into excel templates and produce a comprehensive written report for lenders describing the results and listing findings or exceptions Perform professional interaction with clients, including calls and meetings Qualifications: Strong analytical skills with a willingness to learn new things Naturally inquisitive on all topics relating to transactions Excellent verbal and written communication skills Attention to detail Ability to meet strict deadlines Advanced proficiency in Microsoft Office Excel and Word, Monarch, or other data extraction programs Flexibility for occasional travel 2-4 years of relevant work experience preferred ABL experience is desired but not required Competencies: Verbal Skills: Communicates with a vast vocabulary in a variety of settings and can understand the sophisticated language Numeric Ability: Proficient with basic numerical equations and is comfortable with complex calculations resulting in accurate and sophisticated conclusions Fast-Paced: Very active and results-driven with the ability to juggle the demands of several tasks at once Assertiveness: Enjoys influencing others but is still willing to follow directions from someone else when necessary Sociability: Comfortable working alone, but willing to collaborate as part of a team when necessary Decisiveness: Balances timeliness and deliberation but is comfortable making quick decisions when required Independence: Autonomous yet can accept necessary guidance and instruction Judgment: Balances objective information and instincts to make decisions Education: Bachelors Degree in Accounting or Finance; Masters preferred Company Benefits: Competitive Medical Benefits 401(k) plan with employer contributions Unlimited Paid Time Off Flexibility to work from home Paid Family Care Leave Annual Holiday Retreat Professional Development
    $55k-80k yearly est. 3d ago
  • Regulatory Compliance Auditor

    Pgx

    Remote bank examiner job

    PGX, LLC is a professional services firm serving the many needs of leading consulting firms that provide risk management services including outsourced internal audit needs of community banks and credit unions. Over the years, we have become a leading provider of professional placement for internal auditing and regulatory compliance services to leading consulting firms in the NY/NJ/PA region. We are seeking Regulatory Compliance audit professional to work within the internal audit division of a leading risk management consulting firm located in Central New Jersey to service the needs of Community Banks and Credit Unions. We are seeking an individual with some general banking regulatory compliance experience who has a strong desire to expand their career path with a consulting firm that provides out-sourced Internal Audit services for various financial institutions in the New York Tri-State area. Position: Auditor Responsibilities: Responsible for timely completion of regulatory compliance internal audits for clients Review and assess the adequacy of clients internal controls, policy and procedures and the banks ability to meet regulatory compliance Conduct audit testing of specified area and identify reportable issues and dimension of risk Production of audit reports that include findings and recommendations for improvement of operations and enhancing exiting controls Interface with senior client management Maintain proficiency in all aspects of applicable regulations, policies and best practices in order to provide the most efficient and constructive service to our clients Participate in client meetings and executive presentations Requirements: Self-starter, ability to work in a fast-paced environment while managing competing priorities BS/BA 3-5 years Professional experience (at a community bank or credit union is a plus) Certification or advanced degree a plus (Firm will assist with obtaining CRCM designation) Flexible remote working environment Professional experience that includes operational and/or lending compliance, particularly in the areas of TRID, TILA, RESPA, FCRA, FACT Act, Flood, HMDA (Regulation C), HPML, CRA and Fair Lending, as well as advertising compliance, Bank Protection Act, declined loans, E-Sign, Electronic Fund Transfer Act (Regulation E), Funds Availability (Regulation CC), FACT Act, privacy regulations, identity theft, etc. Banking or mortgage experience a plus Experience in internal auditing not required Strong Computer and analytical skills Familiar with Microsoft PC products Must be "hands-on" and have excellent communication skills Compensation: Salary commensurate with experience. Total compensation includes incentive bonus, retirement plan with match and profit-sharing opportunity and comprehensive benefits including medical, dental, life insurance and LTD. Other Relevant Information: Regularly required to sit, use hands and fingers, handle or feel objects, use tools or controls, reach with hands and arms, talk and/or hear. Frequently is required to stand and walk, and may need to use stairs, escalators, and elevators. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, color vision, depth perception, and the ability to adjust focus Adherence to the Firms dress code, ensuring that personal appearance and conduct are always consistent with a professional image Other relevant requirements will be provided
    $73k-106k yearly est. 60d+ ago
  • Senior Compliance Coding Auditor (REMOTE)

    Central Health 4.4company rating

    Remote bank examiner job

    This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis. Responsibilities Essential Duties: • Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. • Identify coding discrepancies and formulate suggestions for improvement. • Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. • Work with the Office of the CMO and provider leadership to identify and assist providers with coding. • Report findings and recommendations to Compliance Officer or designee, management, and executive leadership. • Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding. • Support compliance policies with government (Medicare& Medicaid) and private payer regulations. • Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines. • Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. • Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested. • Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments. • Assist Director of Compliance with incidents and investigations involving coding and/or documentation. • Work closely with all other Compliance personnel to provide coding/compliance support. • Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates. • Provide training to billing coding staff on coding compliance. • Participate in special projects and performs other duties as assigned. Knowledge/Skills/Abilities: • Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims. • Knowledge in correct application of SNOMED, SNODENT, and LOINC. • Knowledge of medical terminology, disease processes, and pharmacology. • Strong attention to detail and accuracy. • Excellent verbal, written, and communication skills. • Excellent organizational skills. • Ability to multi‐task. • Proficient in Microsoft Office Suite. • Critical thinking/problem solving. • Ability to provide data and recommend process improvement practices. Qualifications MINIMUM EDUCATION: High school diploma or equivalent. MINIMUM EXPERIENCE: 5 years of healthcare experience 4 years of procedural and diagnostic coding REQUIRED CERTIFICATIONS/LICENSURE: UPON HIRE AAPC Certified Professional Coder (CPC) certification OR Certified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA)
    $62k-78k yearly est. Auto-Apply 60d+ ago
  • Healthcare Compliance Auditor (Healthcare Transaction & Strategy)

    Berkeley Research Group 4.8company rating

    Remote bank examiner job

    We do Consulting Differently The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at either the Consultant or Managing Consultant level. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include working with team to develop audit specifications, expert analysis of healthcare claims and supporting documentation, quality control, and development of client deliverables. The work of a Consultant involves execution of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: billing and coding audits, compliance program review, quality control, development of client deliverables, and industry research. The work of a Managing Consultant involves both execution and oversight of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: management of junior staff, quality control, development and presentation of client deliverables, and industry research. This specific position will require knowledge of medical coding and compliance and potential candidates must have medical auditing expertise. Job title and compensation to be determined based on qualifications and experience. Job Responsibilities: Plan and perform medical record audits to determine coding accuracy and compliant claims submission; Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance; Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines; Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement; Serve as a subject matter expert on interpretation and application of coding and documentation guidelines; Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas; Stay current on coding guidelines. Develop analyses using transactional data and/or financial data; Generate client deliverables and make valuable contributions to expert reports; Manage client relationships and communicate results and work product as appropriate; Manage junior staff and delegate assignments as directed by more senior managers; Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions; Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting; Prioritize assignments and responsibilities to meet goals and deadlines. Qualifications: An undergraduate degree (e.g., BS, BA); Active coding certification from either AAPC or AHIMA is required; Preference will be given to candidates that are certified in medical auditing; 2+ years of work experience with a focus on healthcare provider billing and coding; 5-7 years of experience is required for the Managing Consultant level position. Job title to be determined based on relevant qualifications and experience. Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs). Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation. Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements. Required skills include: Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results. Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word. A desire to expand those capabilities is required, as is the ability to train others to use such tools. Commitment to producing high quality analysis and attention to detail. Excellent time management, organizational skills, and ability to prioritize work and meet deadlines. Keen interest in healthcare compliance and healthcare policy. Exceptional verbal and written communication skills. Desire to work within a team environment. Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship. Consultant Salary Range: $70,000 - $150,000 Managing Consultant Salary Range: $100,000 - $230,000 #ThinkBRG #LI-JQ1|#LI-REMOTE About BRG BRG combines world-leading academic credentials with world-tested business expertise purpose-built for agility and connectivity, which sets us apart-and gets you ahead. At BRG, our top-tier professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of proven real-world experience to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges for organizations across the globe. Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking from diverse perspectives that, when paired with our global reach and resources, make us uniquely capable to address our clients' challenges. We get results because we know how to apply our thinking to your world. At BRG, we don't just show you what's possible. We're built to help you make it happen. BRG is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.
    $70k-91k yearly est. Auto-Apply 44d ago
  • CSCA Certified Social Compliance Auditor

    Intertek 4.3company rating

    Remote bank examiner job

    CSCA Auditor - Travel based Intertek, a leading provider of quality and safety solutions to many of the world's top-recognised brands and companies, is actively seeking a Supplier Management / Corporate Social Responsibility CSCA Auditor to join our Business Assurance team. This is a fantastic opportunity to grow a versatile career with a company that wants to build something great with an incredible group of people. Intertek's Business Assurance team goes beyond testing, inspection and certification to look at the underlying elements that make a company and its products successful. Our assurance solutions provide confidence and total peace of mind that a client's operating procedures, systems and people are functioning properly to provide a competitive advantage in the marketplace. What are we looking for? The CSCA Auditor will lead and/or participate as an assessor during all phases of a Supplier Management system audit in accordance with Intertek and Client social, environmental, quality, and security programs. The Lead Auditor is the primary interface with the client before and during the process of all auditing activities. Additionally, the Lead Auditor could also mentor new auditors through witness audits, technical support, and education of both client and sales force as needed. Independence, strong leadership, and management qualities are required in addition to the technical expertise necessary to perform audit assignments. The Lead Auditor will have extensive interaction with clients in an evaluation and audit capacity so tasks and duties shall be commensurate with the responsibilities listed below. The specific tasks and duties are those defined in the Global Supplier Management Program. Other tasks and duties may be assigned outside of the Global Supplier Management Program. This will be a travel-based position, with extensive travel to client sites required. Candidate must be comfortable traveling 3 to 5 days per week. Salary & Benefits Information Individual compensation packages are based on a variety of factors unique to each candidate, including skill set, experience, qualifications, and other job-related reasons. In addition to competitive compensation packages, when working with Intertek, you can expect benefits including medical, dental, vision, life, disability, 401(k) with company match, generous vacation / sick time (PTO), tuition reimbursement and more. What you'll do: Managing all phases of assessments/audits and recommendation for registration. Planning and scheduling assessments/audits and coordinating with team member(s). Representing the assessment team and the company. Total evaluation of supplier sites, reporting non-compliances. Reviewing the social, environmental, quality, and security documentation, assessing the system, conducting audits in order to evaluate the supplier's management system before or after Certification, and for recommending whether the supplier's management system meets the appropriate program and customer requirements. Holding opening and closing meetings with and providing progress updates to suppliers on the conduct of initial assessments, surveillance assessments, follow-up assessments, and results of team findings. Explaining to the supplier non-compliances and other observations. Producing reports to be submitted to the Client and/or Certification Authority Department on each audit documenting all non-compliances. Conducting assigned audits in accordance with contracted client agreements & submit required reports in a timely manner. Manage/Perform management system audits. Evaluate client for compliance and non-compliance to the specifics of the program standards and/or specific customer requirements. Discuss corrective action and non-compliance with the client in a non-advisory capacity. Provide on the job training for auditors and provisional personnel. This position outline is a general guideline and does not represent all encompassing details. The position assumes that the incumbent has both the mental and physical requirements to carry out the above defined duties. Minimum Requirements & Qualifications: Must have APSCA CSCA Certification University level degree and/or equivalent auditing experience (HS Diploma or GED required). At least 1+ years of Social Compliance or Human Rights auditing experience SMETA (Sedex Members Ethical Trade Audit), Amfori BSCI (Business Social Compliance Initiative), SA8000, RBA, or ETI experience (or other related social compliance audit schemes) Ability to travel overnight 3 to 5 days per week, to various worksites and client locations. Possess a valid unrestricted drivers license and the ability to operate a motor vehicle in the performance of the official duties of the position A demonstrated ability to communicate effectively both orally and in writing in the agreed language of the assessment/audit assignments. Ability to work well in an environment and react effectively in stressful situations. Have sound judgment and analytical skills. Ability to understand complex operations in broad perspective. Ability to obtain and assess factual information fairly. Must have strong leadership abilities. Ability to exercise effective time management in completion of assignments and all required reports. Ability to research, interpret, and communicate local legislative requirements. This is a travel-based position; however, applicants must live in and be legally authorized to work in the United States Preferred Requirements & Qualifications: English / Spanish bilingual PHYSICAL REQUIREMENTS: The ability to ascend or descend ladders, stairs, scaffolding, ramps, poles and the like, using feet and legs and/or hands and arms. The ability to express or exchange ideas by means of the spoken word. Must be able to convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. The ability to perceive the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make the discriminations in sound. The ability to exert up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes. Intertek: Total Quality. Assured. Intertek is a world leader in the Quality Assurance market, with a proven, high-quality business model and a global network of customer-focused operations and highly engaged subject matter experts. With passion, pace, and precision we work to exceed our customers' expectations, while engaging with our employees to be 10X in their performance and professional growth. Intertek is a drug-free workplace. As a condition of employment, certain positions may be required to pass a pre-employment drug test based on the type of work that will be performed. We Value Diversity Intertek's network of phenomenal people are our greatest assets, and the diversity they bring fuels our success. Intertek is an Equal Employment Opportunity Employer that values inclusion and diversity. We take affirmative action to ensure all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics. For individuals with disabilities who would like to request accommodation, or who need assistance applying, please email ******************* or call ************** (option #5) to speak with a member of the HR Department. #LI-JC1 * Intertek does not accept unsolicited approaches from agencies and will not pay a fee for any placement resulting from the receipt of an unsolicited resume.
    $65k-87k yearly est. Auto-Apply 30d ago
  • Hospital Compliance Auditor

    Aa067

    Remote bank examiner job

    Hospital Compliance Auditor - (10032671) Description Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago, and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today. The Hospital Compliance Auditor conducts audits systemwide to determine organizational integrity within the Hospital Compliance Program and reviews hospital and provider-based site practices and procedures to ensure they adhere to all relevant healthcare regulations and laws. Audits to evaluate systems, charge capture, and hospital billing including detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. The Hospital Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG compliance standards. The Hospital Compliance Auditor serves as an institutional subject matter expert and authoritative resource on auditing and monitoring practices and interpretation and application of documentation and coding rules and regulations, and medical necessity of services delivered. This position sits within the Healthcare Regulatory and Reimbursement Compliance vertical of the Ethics & Compliance program, is a member of the Hospital Compliance team, and reports to the System Manager, Hospital Compliance. As a successful candidate, you will: Implements and manages a comprehensive systemwide proactive annual audit plan for the Hospital Compliance Program with focus on high-risk areas. Plans and performs hospital compliance related systems, revenue cycle, charge capture and claims audits, including accuracy and adequacy of documentation and coding related to hospital billing and/or medical necessity reviews. Initiates and manages auditing and monitoring as needed in conjunction with investigations and inquiries and assists with corrective action plans. Conducts analysis to identify inappropriate hospital billing and coding practices, identify and report compliance issues and concerns in addition to the claims and financial impact. Makes recommendations for corrective action. Distills and summarizes complex audit findings into digestible education and action items for stakeholders. Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. Assists in validating accuracy of external audits, utilization management reporting, and other inquiries. Assists departmental management with the development of tools, templates, and process improvement recommendations. Assists in documentation and internal evaluation of Ethics & Compliance Program effectiveness consistent with professional standards. Understands where regulatory guidance and hospital policies and procedures might intersect in terms of compliant billing and coding, provide customer feedback to guide their decision making. In conjunction with department manager, provides education and feedback to stakeholders when audit deficiencies are identified. Stays current with Medicare, Medicaid and other third party rules and regulations, CPT, ICD10 coding updates and enhances professional growth and development by participating in educational programs relating to such topics. Serves as a system resource to answer billing appropriateness questions and those arising from audits, including government audits. Maintains knowledge of City of Hope Provider billing and collection systems, including knowledge of report writing capability, and works with Information Systems personnel to identify and request data needed for audits. Qualifications Your qualifications should include: Bachelor's degree; 3 additional years of experience plus the minimum experience requirement may substitute for minimum education.Seven (7) years auditing and coding experience.Certified Coding Specialist (CCS) and/or AHIMA, AAPC or other equivalent recognized coding certification required City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.City of Hope is an equal opportunity employer. To learn more about our Comprehensive Benefits, please CLICK HERE. #LI-RA Primary Location: US-Nationwide-USA-Remote-US-RemoteJob: Compliance AdministrationWork Force Type: RemoteShift: DaysJob Posting: Nov 25, 2025Minimum Hourly Rate ($): 46.580100Maximum Hourly Rate ($): 74.528200
    $53k-78k yearly est. Auto-Apply 1d ago
  • Experienced International Compliance Auditor (HITRUST/NATO)

    Insight Assurance

    Remote bank examiner job

    Insight Assurance is a global audit firm on a mission to transform how organizations achieve cybersecurity and compliance. Founded by former Big 4 (EY) professionals, we deliver next-generation audit services across SOC 2, ISO 27001, PCI DSS (QSA), HITRUST, CMMC (C3PAO), and FedRAMP (3PAO) frameworks. We're not your traditional audit firm - we're tech-enabled, leveraging compliance automation and advanced collaboration tools to make audits faster, smarter, and more impactful for our clients. Recognized on the Inc. 5000 and Fast 50 lists, Insight Assurance is one of the fastest-growing global audit firms, with 170+ professionals supporting nearly 2,000 clients across the Americas, EMEA, and APAC. JOB PURPOSE We are seeking a highly skilled compliance auditor who has secured their CMMC Certified Professional (CCP) certification or would be able to secure their CCP within six months, to join our secure team which assesses client's ability to safeguard government data. The ideal candidate will have demonstrated experience leading compliance initiatives in regulated environments, ensuring adherence to complex regulatory frameworks, and knowledge of CMMC and NIST. Due to the legal requirement of this role, applicants must hold full or dual citizenship in the U.S., Australia, a NATO member country*(listed below), or South Korea, and be able to produce a valid passport. Strong analytical, communication, and collaboration skills are essential to successfully work within our cross-functional teams and with external clients. This is a unique opportunity to make a meaningful impact on data security while working in a dynamic, fast-paced, high-stakes environment. DUTIES AND RESPONSIBILITIES Assessment Planning: Develop a comprehensive assessment plan outlining the scope, objectives, and methodology for evaluating the organization's cybersecurity practices and controls. Evaluate Compliance: Assess the organization's adherence to the HITRUST and CMMC frameworks by reviewing policies, procedures, and technical security controls to ensure they meet the required maturity level. Data Collection: Gather and analyze relevant documentation, including system configurations, security policies, incident response plans, and training materials. Conduct Interviews: Engage with key personnel within the organization to understand the implementation of cybersecurity practices and gauge their familiarity with security protocols. Risk Assessment: Identify potential risks and vulnerabilities in the organization's cybersecurity posture, determining their potential impact on safeguarding governmental data. Reporting Findings: Create detailed reports that document assessment findings, highlighting areas of compliance and non-compliance, along with recommendations for improvement. Provide Guidance: Offer expert advice and best practices to help organizations enhance their cybersecurity measures and achieve compliance with HITRUST and CMMC requirements. Follow-Up Assessments: Conduct follow-up assessments to verify that corrective actions have been implemented, and that the organization is on track to achieve or maintain compliance. Continuous Learning: Stay updated on changes in the HITRUST and CMMC frameworks, cybersecurity threats, and mitigation strategies to provide the most relevant and effective assessments. Client Interaction: Maintain clear communication with clients throughout the assessment process to ensure understanding and facilitate collaboration. SPECIFIC DUTIES Assist the Lead assessor in gathering and evaluating assessment evidence. Evaluates the design and effectiveness of controls. Identifies and communicates preliminary assessment findings for daily checkpoint meetings. Foster stakeholder relationships through proactive communication with clients, colleagues and partners. Proactively communicate with management regarding any potential issues. SKILLS Excellent oral and written communication skills. Ability to work individually as well as collaboratively. A high degree of motivation. Fluency in English is required. EDUCATION Bachelor's degree in accounting, business, cyber security, or management information systems. EXPERIENCE At least 3 years of experience performing IT audit engagements at a Big 4 or other audit/consulting firm. Experience using GRC and compliance automation tools (Vanta, Drata, SecureFrame) is a plus. TRAINING AND CERTIFICATIONS Candidates with an active or working towards RP, RPA, or CCP certification. The ideal client will already possess a CISA, CPA, or CISSP certification. As part of this role, you will also be required to complete CMMC training within your first 6 months. Once Tier 3 suitability has been achieved, participation with the CMMC service line will be expected. A candidate on a path to secure a CMMC certification within six months must possess an approved Intermediate Certification, such as: (ISC)2 CGRC/CAP CompTIA CASP+ CompTIA Cloud+ CompTIA PenTest+ CompTIA Security+ GIAC GSEC BENEFITS Flexible Paid Time Off and paid Holidays Quarterly Performance Bonuses 100% Remote Competitive salary and benefits package. Opportunities for professional growth and development. Collaborative and innovative work environment. Insight Assurance is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. *NATO Country Listing: Australia Barbados Belgium British Virgin Islands Canada Croatia Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Italy Latvia Lithuania Luxembourg Montenegro Netherlands Norway Poland Portugal Romania Slovakia Slovenia South Korea Spain Sweden Turkey US Virgin Islands United Kingdom United States Privacy Notice CCPA: Insight Assurance shares your personal data/information with Greenhouse recruiting because this is the tool we use for the recruitment process. Insight Assurance does not sell personal data/information under any circumstances. You may exercise your rights under personal data protection legislation by reaching out to us via: *********************** or submit a request via mail at 400 N Tampa St. 15th Floor Suite 129, Tampa, FL 33602 Privacy Notice GDPR: This notice informs you about the categories of Personal Data/ Information and the Purpose and Scope of Processing Activities to be undertaken by Insight Assurance (we, us, our), under its job application and recruitment process. We resort to Greenhouse.com as the platform that supports our recruitment process, and therefore your Personal Data/ Information will be Processed on this tool (hosted, shared with, cross-referenced, accessed by our team); we have in place contractual terms and the commitment of Greenhouse.com that ensures the Security and Confidentiality plus Purpose limitation with regards to the Processing of your Personal Data. When you reply to one of your job postings, you voluntarily and freely submit your Personal Data to us; this, allied with the fact that the Processing by us (and over Greenhouse.com) of that Personal Data has the sole Purpose of validating your application and proceeding with the inherent scrutiny and decision, allows us to argue having Legitimate Interest as the applicable Legal Basis to undertake the Processing of your Personal Data under this scope. We are a U.S. based company, hence some or all Personal Data pertaining to you will be hosted in the U.S. The categories of Personal Data under Processing consist of: Identification Contact Education and Professional Interview performance Evaluation You may exercise several Rights as determined under applicable Personal Data Protection legislation, in short: Right of Access - meaning getting information about the Personal Data under Processing by us, except for the information you already know; Right of Erasure - you may ask for us to erase all Personal Data pertaining to you under Processing; this may imply you being excluded from the recruitment process, for without information we cannot proceed with it; Right of Opposition or Restriction of Processing - you may ask us to stop some Processing or restrict the Processing of some Personal Data, this may imply you being excluded from the recruitment process, at our sole discretion also for without information we cannot proceed with it; Rectification - you can rectify your Personal Data at anytime
    $53k-78k yearly est. Auto-Apply 21d ago
  • Coding and Compliance Auditor-Behavioral Health

    Wellsense Health Plan

    Remote bank examiner job

    It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Coding and Compliance Auditor- Behavioral Health performs complex review and adjustments of medical claims to ensure accuracy in claim payments. This is accomplished through data analysis to ensure alignment with payment policies, medical policies, correct coding, and state and federal regulatory requirements. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · Performs operational and financial audits of provider claims to identify overpayments and inform resolution of root cause issues with system configuration, provider contracts, claims operations, provider billing accuracy, and other party liability processes · Adjusts claim payments and adjudicates claims following established recovery guidelines and job aides · Identifies potential recovery projects and reports findings to management · Achieves department production, quality requirements, and individual financial recovery goals · Participates in special projects and initiatives · Assists in developing/revising departmental policies and procedures · Attends and participates in team meetings · Mentors and coaches less experienced staff and new hires Supervision Exercised: · None Supervision Received: · Direct supervision is received weekly Qualifications: Education Required: · Bachelor's Degree or equivalent combination of education, training and related experience required. Experience Required: · 5 + years of work experience in Behavioral Health claims processing and/or health insurance experience working at a Behavioral Health facility or practice. This also includes at least 3 years of work related to medical billing and coding Experience Preferred/Desirable: · Claim audit experience, (Behavioral Health Claims experience desirable) · Prior Medicaid/Medicare exposure · Working knowledge of Facets · SQL training Required Licensure, Certification or Conditions of Employment: · CPC or CCS certification preferred · Successful completion of pre-employment background check Competencies, Skills, and Attributes: · Intermediate to expert knowledge of medical terminology, CPT, ICD9, HCPCS coding is required · Ability to work within large datasets to identify errors, anomalies, and outliers · Works with a high level of accuracy, attention to detail, and with superb work quality · Strong oral and written communication skills; ability to interact effectively with both internal WellSense colleagues as well as with external constituents such as providers and suppliers · Intermediate Excel experience required as well as proficiency using other Microsoft Office products including Word, Outlook, and PowerPoint · Must be able to multi-task, prioritize projects and work well with deadlines Working Conditions and Physical Effort: · Regular and reliable attendance is an essential function of the position · Work is performed in a remote, work from home environment · Ability to work at a computer for entire work shift · No or very limited physical effort required. No or very limited exposure to physical risk About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
    $53k-78k yearly est. 60d+ ago
  • Compliance Auditor - Medical Coding (medical billing and coding)

    Geisinger Medical Center 4.7company rating

    Remote bank examiner job

    Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes The Compliance Auditor position is responsible for supporting the organization's Revenue Management Compliance department in developing, implementing, and administering an effective compliance program. Accurately audits and provides compliance research support to physicians, non-physician practitioners, leadership, and administrative staff on documentation and coding requirements. Determines the adequacy of medical record documentation, coding, and billing, using established compliance auditing and research guidelines for hospital and professional services. Job Duties: Performs compliance audits to determine the adequacy of medical record documentation, billing, and coding, utilizing policies, procedures, Federal and State, laws, regulations, and standard coding guidelines. Evaluates whether documentation and coding patterns present a compliance risk to the organization and provides input on recommended solutions. Identifies training and education needs through compliance audit results prepared and partners with peers to educate physicians and non-physician practitioners, as determined appropriate. Serves as a clinical coding subject matter expert for multiple assigned specialties and utilizes critical thinking when evaluating matters potentially impacting compliance. Maintain an expert level of knowledge with State and Federal healthcare program regulations. Works closely with revenue cycle staff to review systems and/or workflows established to ensure compliance with policies, plans, procedures, laws and regulations. Reviews service line operations or programs to ascertain whether audit results are consistent with established policies, procedures, procedures, Federal and State regulations. Identifies and defines audit scope and criteria. and program of examination for the assigned areas being audited. Responsible for surveying the functions and activities in the assigned areas being audited to determine the nature of operations and adequacy of the system to achieve established objectives. Identifies key control points of assigned areas being audited. Obtains, analyzes, and appraises evidentiary data and available information as a basis for making an informed, objective opinion on the adequacy and effectiveness of systems and the performance of assigned areas being audited. Makes recommendations for improvement and corrective action plans where appropriate. Prepares accurate executive briefs showing the results of assigned areas being audited in accordance with those practices followed within the general scope of the audit parameters. Appraises the adequacy of corrective action taken by management to address findings identified through an external audit engagement. Provides input in the risk assessment process to determine specific areas of focus for compliance risk mitigation as directed by Compliance or Senior Leadership. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. *Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years). #LI-REMOTE Position Details: Minimum one Coding Certification required: --Certified Professional Coder - AAPC --Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) --Registered Health Information Technician (RHIT) - American Health Information Management Association Education: High School Diploma or Equivalent (GED)- (Required) Experience: Minimum of 6 years-Relevant experience* (Required) Certification(s) and License(s): Certified Professional Coder - American Academy of Professional Coders (AAPC), Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association Skills: Computer Literacy, Multitasking, Organizing, Teamwork OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
    $58k-76k yearly est. Auto-Apply 54d ago
  • Senior Compliance Coding Auditor (REMOTE)

    Communitycare Health Centers 4.0company rating

    Remote bank examiner job

    This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis. Responsibilities Essential Duties: * Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements.• Identify coding discrepancies and formulate suggestions for improvement.• Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas.• Work with the Office of the CMO and provider leadership to identify and assist providers with coding.• Report findings and recommendations to Compliance Officer or designee, management, and executive leadership.• Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding.• Support compliance policies with government (Medicare& Medicaid) and private payer regulations.• Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.• Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications.• Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested.• Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments.• Assist Director of Compliance with incidents and investigations involving coding and/or documentation.• Work closely with all other Compliance personnel to provide coding/compliance support.• Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates.• Provide training to billing coding staff on coding compliance.• Participate in special projects and performs other duties as assigned.Knowledge/Skills/Abilities:• Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims.• Knowledge in correct application of SNOMED, SNODENT, and LOINC.• Knowledge of medical terminology, disease processes, and pharmacology.• Strong attention to detail and accuracy.• Excellent verbal, written, and communication skills.• Excellent organizational skills.• Ability to multi‐task.• Proficient in Microsoft Office Suite.• Critical thinking/problem solving.• Ability to provide data and recommend process improvement practices. Qualifications MINIMUM EDUCATION: High school diploma or equivalent. MINIMUM EXPERIENCE: 5 years of healthcare experience4 years of procedural and diagnostic coding REQUIRED CERTIFICATIONS/LICENSURE: UPON HIRE AAPC Certified Professional Coder (CPC) certification ORCertified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA)
    $41k-57k yearly est. Auto-Apply 48d ago
  • Compliance Auditor

    Sanford Health 4.2company rating

    Remote bank examiner job

    Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: Scheduled Weekly Hours: 40Salary Range: 19.00 - 30.50 Union Position: No Department Details Summary Responsible for conducting internal audits and monitors to ensure that the organization's processes and operations are in compliance with laws, corporate guidelines, best practices, and contractual agreements. Job Description Knowledgeable of general audit concepts and techniques, including the type of audits, the approaches and processes, and the subsequent activities, as they relate to internal audits. Demonstrates the ability to interpret Federal rules and regulations. Demonstrates the ability to research regulation from various data sources. Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) code assignment. Demonstrates both knowledge and application of Sanford Health Systems, policies, procedures, and guidelines. Demonstrates commitment to continuous learning for themselves and performs as a role model to other coding staff. Qualifications High school diploma or equivalent preferred. Advanced diploma or degree in Health Information Management or healthcare related field is preferred. Prior relevant compliance work experience is preferable. Two years' experience is required. Certification in one of the following is required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or an equivalent. Certified Healthcare Auditor (CHA) certification to be completed within one year of employment is preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ************** or send an email to ************************.
    $49k-58k yearly est. Auto-Apply 34d ago
  • Corporate Compliance Auditor - Inpatient Focus

    Licking Memorial Health Systems 4.6company rating

    Bank examiner job in Newark, OH

    LMHS Compliance Auditor Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness. When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission - dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community. Position Description Under the general direction of the VP of Financial Services, this position provides overall compliance auditing and monitoring of the Health Systems. This position safeguards the Health Systems compliance with state and federal documentation and billing requirements. Responsibilities * Primary focus on the compliance of home care, patient level of care, and patient status but also responsible for internal auditing of processes and practices to help assure consistency with federal and state law to include but not limited to compliance with the: Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Ohio Department of Health (ODH), Ohio Department of Medicaid (ODM), and Recovery Audit Contractors (RAC). * Communicate with external agencies regarding audits. * Responsible for auditing charge capture processes, coding and billing processes, and assisting in resolution of case or system failures. * Provide consultation in the application of process improvement principles as they relate to the results of any compliance audit functions and findings. * Knowledgeable in Medicare and Medicaid regulations and billing practices to appropriately guide and advise staff and processes. * Offer expertise to departmental personnel and medical staff in the areas of coding, billing, and compliance. * Effectively work with multi-disciplinary groups, skilled with interacting with physicians, nurses, and other healthcare professionals. * Research regulations/rules/laws to effectively analyze concerns and develop well-reasoned solutions based on official resources, recognize and validate assumptions, collect information, and draw meaningful inferences. * Maintain confidentiality and a sense of credibility and reliability. Requirements * Licensed Practical Nurse (LPN), Registered Nurse (RN), or bachelor's prepared individual with significant healthcare and auditing experience. Clinical background is strongly preferred. * A minimum of three to five years in a healthcare setting. * Knowledge of Medicare/Medicaid laws. * Superior interpersonal, analytical and computer skills, as well as the ability to work independently. * Must have the appropriate background and knowledge needed to assess clinical documentation and medical record coding and to analyze data and identify trends and outliers. * Excellent written and verbal communication skills that will support professional communication with all levels of management. * Healthcare auditing experience preferred. * Not a remote position. * LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards. Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.
    $42k-56k yearly est. 60d+ ago

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