Auditor jobs at Dignity Health

Pay range: $29.37 - $44.05 per hour ($61,089 - $91,624 annually), based on experience. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. About St. Charles Health System: St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture. What We Offer: Competitive Salary Comprehensive benefits including Medical, Dental, Vision for you and your immediate family 403b with up to 6% match on Retirement Contributions Generous Earned Time Off Growth Opportunities within Healthcare ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Ambulatory Services Auditor and CDS II REPORTS TO POSITION: System Revenue Integrity Director DEPARTMENT: Revenue Integrity DATE LAST REVIEWED: May 2023 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love and compassion, better health, better care, better value OUR VALUES: Accountability, Caring and Teamwork DEPARTMENTAL SUMMARY: The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver a delightful, transparent and seamless experience to our patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner. POSITION OVERVIEW: The Ambulatory Services Auditor and Clinical Documentation Specialist II is responsible for conducting chart reviews of outpatient, inpatient and ambulatory service medical documentation across St. Charles Health System to ensure compliance with ICD-10-CM and CPT-4 coding regulations, rules and guidelines. This position will also provide education, feedback and guidance to multiple parties, as needed. This position does not directly manage any other Caregivers. ESSENTIAL FUNCTIONS AND DUTIES: Conduct system-wide pre- visit or post-visit chart reviews of professional services to include both hospital and clinic/office settings of care. Perform audits on/for the HIM Professional Services Coding team and provide feedback and education as needed to ensure compliance with quality coding standards. Evaluate medical records to ensure the accuracy of clinical documentation to support the acuity of the patient, risk profiles for HCC capture and recapture, and diagnostic and procedural code integrity in compliance with ICD-10-CM and CPT-4/HCPCs rules and guidelines. Develop and update procedure manuals to maintain standards for correct coding. Conduct system-wide education and training on complete documentation and other key concepts for supporting professional fee coding and billing in group setting or on an individual basis. Assist in setting the direction for and providing coding compliance and education. Provide technical guidance to physicians and other departmental staff in identifying and resolving issues such as incomplete or missing records, or codes that do not conform to approved coding guidelines or organizational standards. Recommend process changes and improvements within departmental and operational policies and procedures or system changes to reduce losses or improve efficiency. Monitor trends and prepare reports on such topics as documentation or coding issues and denied claims, for review by management. Supports the vision, mission and values of the organization in all respects. Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change. Provides and maintains a safe environment for caregivers, patients and guests. Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization's corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings. Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate. May perform additional duties of similar complexity within the organization, as required or assigned. EDUCATION Required: High school diploma or GED Preferred: Associates degree in Health Information Technology or related field LICENSURE/CERTIFICATION/REGISTRATION Required: RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN or LPN Preferred: CPMA CRC, RN, LPN EXPERIENCE Required: Minimum of 3-5 years of coding, auditing, or clinical experience required. Physician Evaluation and Management coding experience required. Must meet all competencies of the Ambulatory Auditor and CDS I position prior to promotion. Knowledge of current Medicare regulations, including MPFS, IPPS and OPPS. Preferred: Inpatient, Outpatient, and Ambulatory services coding preferred. PERSONAL PROTECTIVE EQUIPMENT Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely. ADDITIONAL POSITION INFORMATION: PHYSICAL REQUIREMENTS: Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level. Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation. Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing. Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle. Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level. Exposure to Elemental Factors Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category No Risk for Exposure to BBP . Schedule Weekly Hours: 40 Caregiver Type: Regular Shift: First Shift (United States of America) Is Exempt Position? Yes Job Family: AUDITOR Scheduled Days of the Week: Monday-Friday Shift Start & End Time: Flexible within core working hours

Department/Unit: Health Information Management Work Shift: Day (United States of America) Salary Range: has remote opportunity Professional Coding Auditor will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding/charging/denials follow-up. Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes. Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines. Provide education, instruction and training to providers and coding staff. Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed. CPC certificate upon Hire - Required Two years or more prior experience in professional fee coding - required Essential Duties and Responsibilities Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by providers to assure compliance with federal and state regulations and insurance carrier guidelines. Ensuring established productivity and quality standards are met. Complex coding skill set required to act as service line expert. Assist Supervisor in the daily operations of coding team(s) in a Team Lead position, ensuring staff are meeting established coding/charge processing productivity and quality standards. Assume supervisory tasks for the assigned coding staff in absence of Supervisor. Perform accurate and compliant coding of CPT and ICD-10 diagnosis codes. Define and submit coding/edit rules for consideration to streamline coding accuracy and efficiency within multiple interfaced systems. Participate as a workflow expert in all levels of application testing to include test script building, script processing through varying test systems, charge import into applicable systems and detailed review of accuracy for each process. Assist with the implementation, testing, troubleshooting and maintenance of third-party vendor applications software. Assist in preparing, overseeing, and approving staff schedule to meet the needs of the department. Orient and train, provide feedback, and evaluate the staff as needed. Assist in establishing department goals and assure goals are achieved utilizing LEAN management skills. Participate in the recruitment and interview process to fill personnel vacancies. Perform System Manager tasks for specified applications in his/her absence to include: compile and create daily reports, Import charges into applicable systems. Research/correct coding validation errors during charge import. Assist in creating and updating policies and procedures to include system development and maintenance documentation. Perform timely medical record chart reviews (which could include prospective, concurrent & retrospective auditing) to ensure documentation and selection of HCC diagnosis codes meet the requirements set forth by CMS and the Official ICD-10-CM Guideline for Coding and Reporting. Code chronic disease that meets HCC and Risk Adjustment criteria. Validate missed coding opportunities. Conducts professional fee billing integrity reviews/audits for AMHS, including reviewing medical record documentation and coding to assess compliance with related rules and regulatory requirements, and to identify clinical documentation improvement opportunities. Identify trends based on audit/review findings and formulate recommendations for follow-up education and corrective actions. Effectively communicate and educate relevant parties with the results of review/audit activity; and help with development of related action plans. Assist with Denials Management to determine root causes and provide feedback and training to providers/staff to reduce denials. Acts as a liaison for external audits and organizes the process. Implements necessary changes/education based on findings. Attend and contribute in all PCO staff meetings, department meetings and all other meetings assigned. Fulfills department requirements in terms of providing work coverage and administration notification during periods of personnel illness, vacation, or education. Assume responsibility for professional development by participating in webinars, workshops and conferences when appropriate. Ability to work well with people from different disciplines with varying degrees of business and technical expertise. All other duties as assigned. Qualifications High School Diploma/G.E.D. - required Two years or more prior experience in professional fee coding - required Knowledge of multiple coding specialties. - preferred Working knowledge and experience with provider professional fee coding and charge processing. Complex coding skill set required. Computer experience, windows environment with proficiency in Microsoft Word and Excel is required. Excellent verbal and written communication skills. (High proficiency) CPC, CCA, CCS, COC, RHIT, or RHIA - required Equivalent combination of relevant education and experience may be substituted as appropriate. Thank you for your interest in Albany Medical Center! Albany Medical is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Pay range: $29.37 - $44.05 per hour ($61,089 - $91,624 annually), based on experience. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. About St. Charles Health System: St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture. What We Offer: Competitive Salary Comprehensive benefits including Medical, Dental, Vision for you and your immediate family 403b with up to 6% match on Retirement Contributions Generous Earned Time Off Growth Opportunities within Healthcare ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Ambulatory Services Auditor and CDS II REPORTS TO POSITION: System Revenue Integrity Director DEPARTMENT: Revenue Integrity DATE LAST REVIEWED: May 2023 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love and compassion, better health, better care, better value OUR VALUES: Accountability, Caring and Teamwork DEPARTMENTAL SUMMARY: The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver a delightful, transparent and seamless experience to our patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner. POSITION OVERVIEW: The Ambulatory Services Auditor and Clinical Documentation Specialist II is responsible for conducting chart reviews of outpatient, inpatient and ambulatory service medical documentation across St. Charles Health System to ensure compliance with ICD-10-CM and CPT-4 coding regulations, rules and guidelines. This position will also provide education, feedback and guidance to multiple parties, as needed. This position does not directly manage any other Caregivers. ESSENTIAL FUNCTIONS AND DUTIES: Conduct system-wide pre- visit or post-visit chart reviews of professional services to include both hospital and clinic/office settings of care. Perform audits on/for the HIM Professional Services Coding team and provide feedback and education as needed to ensure compliance with quality coding standards. Evaluate medical records to ensure the accuracy of clinical documentation to support the acuity of the patient, risk profiles for HCC capture and recapture, and diagnostic and procedural code integrity in compliance with ICD-10-CM and CPT-4/HCPCs rules and guidelines. Develop and update procedure manuals to maintain standards for correct coding. Conduct system-wide education and training on complete documentation and other key concepts for supporting professional fee coding and billing in group setting or on an individual basis. Assist in setting the direction for and providing coding compliance and education. Provide technical guidance to physicians and other departmental staff in identifying and resolving issues such as incomplete or missing records, or codes that do not conform to approved coding guidelines or organizational standards. Recommend process changes and improvements within departmental and operational policies and procedures or system changes to reduce losses or improve efficiency. Monitor trends and prepare reports on such topics as documentation or coding issues and denied claims, for review by management. Supports the vision, mission and values of the organization in all respects. Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change. Provides and maintains a safe environment for caregivers, patients and guests. Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization's corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings. Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate. May perform additional duties of similar complexity within the organization, as required or assigned. EDUCATION Required: High school diploma or GED Preferred: Associates degree in Health Information Technology or related field LICENSURE/CERTIFICATION/REGISTRATION Required: RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN or LPN Preferred: CPMA CRC, RN, LPN EXPERIENCE Required: Minimum of 3-5 years of coding, auditing, or clinical experience required. Physician Evaluation and Management coding experience required. Must meet all competencies of the Ambulatory Auditor and CDS I position prior to promotion. Knowledge of current Medicare regulations, including MPFS, IPPS and OPPS. Preferred: Inpatient, Outpatient, and Ambulatory services coding preferred. PERSONAL PROTECTIVE EQUIPMENT Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely. ADDITIONAL POSITION INFORMATION: PHYSICAL REQUIREMENTS: Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level. Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation. Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing. Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle. Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level. Exposure to Elemental Factors Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category No Risk for Exposure to BBP . Schedule Weekly Hours: 40 Caregiver Type: Regular Shift: First Shift (United States of America) Is Exempt Position? Yes Job Family: AUDITOR Scheduled Days of the Week: Monday-Friday Shift Start & End Time: Flexible within core working hours

Why work with us? The North American branch of Generali Global Assistance offers a diverse and inclusive work environment while employees work towards making real difference in the lives of our clients. As an Organization, we pride ourselves with offering white glove service while being mindful of corporate responsibility and our environmental footprint. Employees enjoy a plethora of benefits to include: A diverse, inclusive, professional work environment Flexible work schedules Company match on 401(k) Competitive Paid Time Off policy Generous Employer contribution for health, dental and vision insurance Company paid short term and long term disability insurance Paid Maternity and Paternity Leave Tuition reimbursement Company paid life insurance Employee Assistance program Wellness programs Fun employee and company events Discounts on travel insurance Salary Range: $80,000.00 - $120,000.00/yr No Work VISA or Sponsorship Available. Who are we? Generali Global Assistance is proudly part of the Europ Assistance Group brand and our products utilize a number of corporate and product brands. The brands for our North American team include the following: CSA: US travel insurance brand for retail and lodging partners. Learn more here. Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products. Learn more here. GMMI: the industry standard for global medical cost containment and medical risk management solutions. Learn more here. Iris, Powered by Generali: identity and digital protection solution. Learn more here. Trip Mate: US travel insurance brand for tour operator, cruise and airline partners. Learn more here. What you ll be doing. Job Summary: Under general supervision, the Auditor I verifies the financial status and operating procedures of the institution through a systematic program of audits. Interacts with administrative and enforcement agencies; monitors systems and solves problems. Principal Duties and Responsibilities: To perform the audit activities for approved audit plan engagements. To participate in the planning phase of the assigned audits, analyzing the key risks, scope, objectives, and tests to be performed, as well as documenting this information in the relevant documents. To perform walkthroughs of significant audit areas and the relevant tests to examine and evaluate the adequacy and effectiveness of the controls defined during the fieldwork phase. Likewise, to prepare the formalization of these tests in accordance with established standards. To utilize data analytics techniques and tools to support tests and conclusions. To provide support for an objective and informed opinion of the risk exposure. To assist in presenting verbal and written results of audit activities. To perform regular follow up of the issues detected in the Audit to ensure their adequate remedial according to the action agreed. To assist in the development of the annual internal audit plan using a risk-based approach by participating in annual Risk Assessment. To respond to ad hoc requests and participate in spot projects. To support in the managerial tasks of the function. To contribute to the continuous improvement of the department. To stay up to date with evolving industry and regulatory changes impacting the insurance sector. Required / Desired Knowledge, Experiences and Skills: Advanced knowledge of audit, accounting, finance principles, insurance regulatory environment. Strong interpersonal skills, with the ability to promote ideas and work effectively at all levels within the organization. Strong oral and written communication skills, with the ability to report key issues, their business impact, and to make recommendations for improvement clearly and succinctly. Strong analytical skills with capacity to onboard new topics. Ability to organize and analyze information in a timely manner, good project management skills and ability to manage multiple priorities. Self-motivated with ability to take ownership of an audit program, work on it autonomously and deliver a high-quality result within the given timeframe. Objective and fact-based in the evaluation of the audited area. Strong team spirit to contribute to the development of a small department and to interfere with the international Generali Group Audit community. Integrity, confidence & accountability, flexibility, and life-long learning. Resilience, stress management, time management and problem solving. Willingness to travel and spend short periods in different states. Prior experience in an international/complex environment. Advanced Excel knowledge, data analytics software knowledge (IDEA) is a plus. Fluent English both spoken and written. Education/Certifications: Bachelor s degree in economics, Business Administration, Finance or Law. Initial/Solid experience of internal or external auditing ideally in the Insurance sector and/or with Certified Internal Auditor or Accountancy qualification. Where you ll be doing it. This is a hybrid role based out of our New York, NY office. As a hybrid role, you will be working onsite 1 day a week and working from home 4 days a week. When you ll be doing it. While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need. Apply today to begin your next chapter. Don t meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if you re excited about this role but your past experience doesn t align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles. California Residents - Privacy Notice for California Residents Seeking Employment with Generali Global Assistance is available here: *************************************************************************************************** The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company s Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.

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)

JOIN TEAM TRILOGY Weekly pay, health and dental after your first month, student loan repayment, a competitive 401(k) match, and more! Make a living while you make a difference at Trilogy Health Services - a senior living provider with the continuous goal of being the Best Healthcare Company in The Midwest. POSITION OVERVIEW Job Summary Serves as a key liaison between IT, audit, and business teams to execute SOX 404B testing and operational IT audits. Evaluates IT controls, identifies risks, and supports remediation efforts while ensuring compliance with HIPAA, NIST, and other regulatory standards. Roles and Responsibilities * Acts as the primary liaison between IT, IS, external audit, and business/IT application control owners to ensure effective communication and collaboration. * Executes SOX 404B testing over IT General Controls (ITGC), IT application controls (ITAC), and key cybersecurity controls across financially relevant systems. * Plans and performs walkthroughs, defines populations, selects samples, evaluates configurations/parameters, reperforms automated control logic, and assesses exceptions to support auditor reliance. * Leads and executes non-SOX operational IT audits- plan and perform routine monitoring and testing of critical IT systems * Identifies control deficiencies and risks, recommends mitigation strategies in partnership with control owners, and follows up on remediation. * Prepares clear, concise audit reports and present findings to management, routinely tracks audit projects, resource hours, and progress against plan; analyzes trends and outcomes; and provide reporting to support forecasting and continuous improvement of the audit plan. * Supports the design and implementation of automated solutions for recurring audit and monitoring activities. * Provides advanced data and reporting support to the audit team-assist with extracting system reports, structuring large datasets, and performing complex analyses (e.g., building dynamic pivot tables, reconciling data across sources, and executing comparative reviews) to enable efficient testing and insightful conclusions. * Participates in annual IT risk assessments and consult with stakeholders in development of the IT audit plan. * Assesses compliance with internal IT policies, regulatory requirements and industry standards, including HIPAA, NIST, and state-specific guidance. * Reviews third-party and vendor risk management practices, including evaluating SOC 1 and SOC 2 reports, testing key controls, assessing subservice organizations, and mapping Complementary User Entity Controls (CUECs) to internal processes to ensure comprehensive coverage and compliance. * Audits data privacy and governance practices, including encryption and data lifecycle management. * Evaluates and participates in disaster recovery, business continuity, and incident response plans. * Consults with internal teams on process and control development, quality improvement, and remediation activities. * Monitors industry trends and emerging technologies to proactively identify risks, recommend improvements, and provide guidance and training to team members and control owners on relevant updates and best practices. * Other duties as assigned. Qualifications Education: Bachelor Degree Experience: 3-5 years Licenses and Certifications Certified Information Systems Auditor (CISA) strongly preferred. Physical Requirements Sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 50lbs. Must be able to maintain verbal and written communication with co-workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus. LOCATION US-KY-Louisville Trilogy Health Services 303 N. Hurstbourne Parkway Louisville KY BENEFITS * Competitive salaries and weekly pay * 401(k) Company Match * Mental Health Support Program * Student Loan Repayment and Tuition Reimbursement * Health, vision, dental & life insurance kick in on the first of the month after your start date * First time homebuyers' program * HSA/FSA * And so much more! TEXT A RECRUITER Lauren ************** LIFE AT TRILOGY Whether you're looking for a new chapter, a change of pace, or a helping hand, Trilogy is committed to being the best place that you've ever belonged. Flexibility is what you want, and flexibility is what you'll get. Come into the office because you want to - not because you have to. At Trilogy, we're proud to embrace a hybrid work environment that allows you both the convenience of working from home and the flexibility of meeting with your co-workers in person. With collaborative workspaces, rotating cubicles, and meditation areas, our freshly renovated Home Office will accommodate the working style that works best for you. Six months of training, orientation, and fun! We believe in setting our employees up for success. That's why your first six months are referred to as your "blue-badge" period - a time where you are encouraged to ask questions, ask for help when needed, and familiarize yourself with the company culture. Even when your blue badge period ends, you can rest assured that the Trilogy team will always have your back. ABOUT TRILOGY HEALTH SERVICES As one of Fortune's Best Places to Work in Aging Services, a certified Great Place to Work, and one of Glassdoor's Top 100 Best Companies to Work, Trilogy is proud to be an equal opportunity employer committed to helping you reach your full potential and to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy or any other protected characteristic as outlined by federal, state or local laws. FOR THIS TYPE OF EMPLOYMENT STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT. Job Summary Serves as a key liaison between IT, audit, and business teams to execute SOX 404B testing and operational IT audits. Evaluates IT controls, identifies risks, and supports remediation efforts while ensuring compliance with HIPAA, NIST, and other regulatory standards. Roles and Responsibilities * Acts as the primary liaison between IT, IS, external audit, and business/IT application control owners to ensure effective communication and collaboration. * Executes SOX 404B testing over IT General Controls (ITGC), IT application controls (ITAC), and key cybersecurity controls across financially relevant systems. * Plans and performs walkthroughs, defines populations, selects samples, evaluates configurations/parameters, reperforms automated control logic, and assesses exceptions to support auditor reliance. * Leads and executes non-SOX operational IT audits- plan and perform routine monitoring and testing of critical IT systems * Identifies control deficiencies and risks, recommends mitigation strategies in partnership with control owners, and follows up on remediation. * Prepares clear, concise audit reports and present findings to management, routinely tracks audit projects, resource hours, and progress against plan; analyzes trends and outcomes; and provide reporting to support forecasting and continuous improvement of the audit plan. * Supports the design and implementation of automated solutions for recurring audit and monitoring activities. * Provides advanced data and reporting support to the audit team-assist with extracting system reports, structuring large datasets, and performing complex analyses (e.g., building dynamic pivot tables, reconciling data across sources, and executing comparative reviews) to enable efficient testing and insightful conclusions. * Participates in annual IT risk assessments and consult with stakeholders in development of the IT audit plan. * Assesses compliance with internal IT policies, regulatory requirements and industry standards, including HIPAA, NIST, and state-specific guidance. * Reviews third-party and vendor risk management practices, including evaluating SOC 1 and SOC 2 reports, testing key controls, assessing subservice organizations, and mapping Complementary User Entity Controls (CUECs) to internal processes to ensure comprehensive coverage and compliance. * Audits data privacy and governance practices, including encryption and data lifecycle management. * Evaluates and participates in disaster recovery, business continuity, and incident response plans. * Consults with internal teams on process and control development, quality improvement, and remediation activities. * Monitors industry trends and emerging technologies to proactively identify risks, recommend improvements, and provide guidance and training to team members and control owners on relevant updates and best practices. * Other duties as assigned. Qualifications Education: Bachelor Degree Experience: 3-5 years Licenses and Certifications Certified Information Systems Auditor (CISA) strongly preferred. Physical Requirements Sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 50lbs. Must be able to maintain verbal and written communication with co-workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus. Weekly pay, health and dental after your first month, student loan repayment, a competitive 401(k) match, and more! Make a living while you make a difference at Trilogy Health Services - a senior living provider with the continuous goal of being the Best Healthcare Company in The Midwest.

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)

The Internal Auditor II works in a self-directed team environment to execute internal audits as defined by management and the Audit Committee with progressive latitude for team goal setting, initiative and independent judgement on collective work products. The auditor works to identify and evaluate organizational risk, recommends and monitors mitigation action and supports the development of the annual audit plan. Essential Functions: Conduct operational, performance, financial and/or compliance audit project work including, business process survey, project planning, risk determination, test work, recommendation development and monitoring and validation of remediation Work within a self-directed team environment with limited direct supervision, employing significant creativity in determining efficient and effective ways to achieve audit objectives Actively participate in the development and implementation of a flexible risk-based, flexible annual audit plan considering control concerns identified by senior management Coordinate and collaborate on internal audit projects including assessing the adequacy of the control environment to achieve defined objectives in accordance with the approved audit program and professional standards Facilitate communication of organizational risks and audit results to business owners through written reports and oral presentations and provide support and guidance to organizational leadership on effective internal control design and risk mitigation Coordinate, monitor, and complete team tasks within agreed upon timeframes and meet individual and team project timelines, which may be aggressive at times. Influences team prioritization and scheduling of work, problem solving, assignment of tasks, and takes initiative when problems arise. Provides cross-training of team members Support management in onboarding new team members through mentorship, shadowing, and training of all required functions and processes and influence standards for expected team behaviors Assist in the coordination of external audits of CareSource by government agencies, accounting firms, etc. Develop and maintain productive professional relationships with CareSource staff and management by developing trust and credibility Significant interaction with others in the Department of differing skillsets (clinical, IT, etc.), organizational management and staff throughout CareSource, including interaction with the senior most levels Coordinate audit projects as necessary with other CareSource functions, including CareSource Assurance teams Generally conform to IIA standards and maintain all organizational and professional ethical standards, even in difficult or challenging situations Willing to accept feedback, coaching and criticism from others, including peers and management both in Internal Audit or outside of Internal Audit, reflect on the information, and adapt when appropriate Perform any other job duties as requested Education and Experience: Bachelor's degree in finance, business management, healthcare administration, accounting or related field or equivalent years of relevant work experience is required Master of Business Administration (MBA), or other graduate degree is preferred A minimum of three (3) years of finance, business management, healthcare administration, accounting or related field is required; experience in internal auditing or public accounting is preferred Knowledge of audit principles and IIA Standards and Code of Ethics required Experience in risk and control assessments is preferred Experience in thoroughly documenting process flows and controls in financial, and/or business operations cycles preferred Experience with Sarbanes Oxley 404 or Model Audit Rule preferred Experience in health care or insurance fields is preferred Competencies, Knowledge and Skills: Strong communication skills, including proper writing skills adaptable for the audience and purpose, presentation skills for internal or external audiences and senior management, and interpersonal skills sufficient to develop strong professional relationships with CareSource management and staff Solid critical thinking skills including professional skepticism and problem resolution Data analysis and trending skills and ability to compose and present reports using audit data Ability to work in a matrix environment with responsibility for multiple deliverables for multiple functional areas within CareSource Team and customer service oriented Collaborative mindset and ability to operate in a self-directed team environment with collective accountability Strong ability to adapt to changing environment Strong self-leadership, organizational and time management skills Driven to proactively seek relevant development, education and training opportunities Strong sense of integrity and ethics in performance of all duties Takes initiative to identify and influence innovative process improvement Self-driven to work independently within a team environment Success in working in a self-directed matrixed environment Advanced level experience in Microsoft products Licensure and Certification: CIA, CISA, CPA, CMA, CRMA or other appropriate finance, IT or internal audit licensure or certification is preferred Working Conditions: Most work will be performed in an office or virtual setting; however, performing onsite audits may also be necessary depending on assignments May be required to sit or stand for extended periods Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

OBJECTIVE: Act as main point of contact for all Asset Facility Audits. Take pictures to support all documented remarks both good and bad to make owners aware of asset condition. Generate reports to include recommendations for corrective action and/or correct potential loss exposures identified. ESSENTIAL FUNCTIONS (other duties as assigned) Conduct one Asset Facility Audit at all PIPESTONE farms annually. Work by oneself and be self-motivated, self-reliable and trustworthy. Write a work schedule that is flexible, effective, and efficient. Inspecting facilities from subgrade to roofing system and noting condition of all key points within on specified asset audit document. Taking digital pictures to support all documented remarks both good and bad with key focus on any necessary recommendations to make owners aware of asset condition Generate reports with information necessary to include recommendations for corrective action and/or correct potential loss into Maintenance Connection and ensure photos with documents are shared with proper team members - self follow up, PRM, PRM project team Estimate timeline for action needed: 1 = within 1 year 2 = 2-3 years 3 = 4-5 years Cost estimates: 1 = 1 estimate backed by previous data 2 = rough estimate 3 = ball park numbers Write a detailed and a summary report for each audit and email them to the following people: PRM Items: Email to PRM Administrative Assistant. Cc: Director of Air Filtration and Ventilation, PRM Director, PRM Supervisor, VP of Asset Management. Detailed Report: Farm Manager, Farm Production Supervisor, Regional Production Director, Regional VP of Production, Director of Ventilation and Air Filtration, PRM Director, PRM Supervisor, VP of Asset Management, Executive VP of Pipestone Management. Summary Report for Shareholder Presentation: Director of Air Filtration and Ventilation, VP of Asset Management, Executive VP of Pipestone Management. Once approved by this group, email the summary to the Relationship Manager and the Shareholder Communication Coordinator. Meet and interact with fellow employees/farm managers/supervisors and contractors. Complete appropriate electronic documentation related to auditing, including timecards, service requests, mileage logs, credit card/expense reports and emails. POSITION SPECIFICATIONS Education: B.S. degree with an agricultural or construction management focus preferred Experience: 3 to 4 years construction/maintenance experience or post-secondary education/training in these fields may be substituted for B.S. degree Work Environment: Agricultural swine environment in rural area Office/hybrid ability Physical Requirements: Standing, walking and ability to be on feet 8 to 10 hours per day Frequent bending, reaching, squatting and kneeling Frequent use of one or both hands/arms to grasp or pull Frequent lifting of objects weighing 3-20 pounds Occasional bending while pulling and/or lifting objects weighing up to 50 pounds, or requiring up to 50 pounds of force to move Ability to climb ladders and stairways Able to work within the atmosphere inside and outside a swine confinement barn Ability to work in temperatures ranging from +100 degrees F to subzero Ability to attend and participate in meetings of various lengths Additional Requirements: Must have valid driver's license and reliable transportation to get to work and attend meetings Overnight travel required Compensation, Pay & Benefits: $70,000-$95,000 base salary, depending on experience Benefit Package includes Paid Single Health Insurance, Family Health Coverage Available Dental/Vision/Life/Disability Insurance Retirement Plan Holidays & Paid Time Off

Concentra is recognized as the nation's leading occupational health care company.With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America's workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees. The Auditor, Coding & Compliance - Occupational Medicine and Specialty will perform detailed coding and documentation audits and reviews to ensure compliance with clinical and coding guidelines. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one on one, and group education and training to employed and contracted clinicians. The Auditor will provide in-depth, real-time feedback on appropriate documentation, charge capture and Level of Service code selection. A thorough knowledge of state specific worker's compensation coding and billing guidelines is required for this position. The audit findings are compiled and analyzed and then the results scheduled and presented to the clinical by the auditor, via telephone of video platforms in accordance with the clinician's schedule. Responsibilities * Complete compliance audits for designated clinicians/centers consistent with established audit protocols and nationally recognized guidelines. * Meet the production and QA standards as set out in Concentra Coding and Compliance policies. * Analyze audit findings and identify/assess potential compliance risks related to coding and billing and notify clinical leadership regarding outliers. * Organize and present the audit findings to each clinician as indicated by either the audit results, denial and down coding trends, and/or as requested by medical leadership, center leadership or Central Billing Office leadership * Schedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises. * Assist CBO's with reconsideration, appeals process and coding support as requested * Participate in special projects and collaborate with other departments to support coding, auditing, and compliance initiatives. * Provide clinician support, education and training related to the quality of documentation, level of service, procedure and diagnosis coding consistent with established coding guidelines and standards * Collaborate with Medical Leadership in development of clinician training plans and for active support in the training process under guidance of coding leadership * Monitor Coding and State Workers' Compensation changes to ensure that most current information is available * Ensure adherence to all State and Federal guidelines applicable to coding, billing and documentation compliance for Worker's Compensation in all served markets This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Qualifications Education Level: High School Diploma or GEDCertifications and/or Licenses: * Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) * Maintain a coding credential from AAPC or AHIMA organization. * Must complete CEUs to maintain this credential bi-annually or as required by the organization * Obtain and maintain membership to the AAPC or AHIMA organization * Experience in lieu of required education is acceptable: Yes Job-Related Experience * Customarily has at least four (4) years of experience working as a certified Coder * Prefer at least three (3) years in coding and compliance/clinical audit field * Prefer experience in dealing directly with, and in presenting work product to clinicians Job-Related Skills/Competencies * Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility * Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions * Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism * The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies * Coding and auditing experience * Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access and similar databases * Working knowledge of routine and non-routine concepts, practices and procedures within billing and coding * Strong understanding and application of Evaluation and Management Guidelines * Excellent process and time management skills * High degree of accuracy and attention to detail * Organized and ability to analyze multiple sources of data * Proficient written, oral communication * Work independently and as part of a team * Able to multi-task * Ability to meet multiple deadlines * Expertise in scheduling and facilitating Training and presentation skills (in person and virtual) * Familiarity with state specific workers' compensation regulations * Coding analytics experience Additional Data Employee Benefits: * $2,000 Sign On Bonus * We offer an internet service reimbursement * Annual certification reimbursement (AAPC or AHIMA) * Monthly CEUs (Continuing Education Units) credits. * Company issued laptop and two monitors for improved productivity * Internal subscriptions for coding manuals, and access to Codify. * Healthcare benefits including medical, dental vision - PPO and HMO plans * Internal growth opportunities in leadership * PTO Accrual * 401(k) Retirement Plan with Employer Match * Life & Disability Insurance * Colleague Referral Bonus Program * Tuition Reimbursement * Commuter Benefits * Dependent Care Spending Account * Employee Discounts We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation, if required. * This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management* Concentra is an Equal Opportunity Employer, including disability/veterans

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 ************************.

The Compliance Operations Auditor reports to the Director of Compliance. This position is responsible for conducting comprehensive internal audits and reviews of Central Health's diverse operational processes. This role ensures robust compliance with applicable laws, regulations, and internal policies, while also assessing adherence to established performance standards. The Operations Auditor plays a critical role in supporting the organization's mission by proactively identifying potential risks, rigorously evaluating the effectiveness of internal controls, and developing actionable recommendations that strengthen accountability, enhance efficiency, and ensure comprehensive compliance across all departments. This position is instrumental in cultivating a culture of continuous improvement and operational excellence throughout Central Health's administrative functions, including but not limited to finance, procurement, human resources, and technology. Key responsibilities also include active participation in the development of the organization's annual audit plan, meticulous execution of assigned audit tasks to ensure satisfactory outcomes, and thorough documentation of audit findings and evaluations. This role is crucial for maintaining the integrity and effectiveness of the organization's operations and financial reporting. The ideal candidate will be detail-oriented, possess a strong analytical mindset, and demonstrate an unwavering commitment to upholding the highest standards of compliance and control. Responsibilities Essential Functions: Conducts in-depth internal audits to systematically assess the effectiveness of internal controls, accuracy of operational processes, and overall efficiency across various functional areas. Performs rigorous audits of vendors to ensure strict adherence to contractual obligations, conflicts of interests and regulatory requirements. Performs audits of Employee and Board of Manager files, ensuring strict adherence to privacy regulations, conflicts of interests and regulatory requirements. Leads internal audits related to Fraud, Waste, and Abuse (FWA) and analyzes delegated oversight policies, providing evidence-based recommendations for process improvements and changes consistent with all applicable state and federal regulations and guidelines. Analyzes complex operational and financial data to identify and report patterns indicative of fraud, waste, and/or abuse; evaluates results from prior audits to discern FWA trends and proposes proactive preventative and corrective actions. Translates complex fraud, waste, and abuse information into clear, concise, and easy-to-understand communications for diverse stakeholders, ensuring effective message delivery both verbally and in writing. Continuously monitors changes in relevant laws, regulations, and industry standards, maintaining up-to-date knowledge of best practices in audit methodologies and internal controls. Actively contributes to the development and strategic implementation of robust risk management strategies across the organization. Develops and recommends impactful improvements to policies, procedures, and systems designed to enhance the overall internal control environment. Prepares comprehensive monthly reports detailing audit findings, activities, and recommendations for executive leadership. Performs other duties as assigned to support the operational auditing function and organizational objectives. Prepares monthly reports of audit findings/activity. Other duties as assigned. Knowledge, Skills and Abilities: Thorough familiarity with Sarbanes-Oxley Act (SOX) requirements and other relevant regulatory frameworks (e.g., HIPAA, state public information acts). Comprehensive knowledge of audit methodologies, including risk assessment, sampling methods, and internal control testing. Solid understanding of both internal and external audit processes and their interdependencies. Knowledge of industry-specific regulations, such as those pertaining to healthcare, finance, or government sectors. Understanding of IT systems, databases, and software relevant to financial reporting and auditing. Strong analytical skills with a proven ability to analyze complex operational and financial data, identify discrepancies, discern trends, and assess associated risks. Proficiency in conducting root cause analysis and formulating practical, effective corrective actions. Knowledge of cybersecurity risks and controls, data privacy regulations, and IT governance frameworks. Knowledge of common fraud schemes and red flags. Skilled at managing high functioning interdisciplinary teams of professionals. Excellent organizational skill with the ability to manage multiple priorities. Knowledge of applicable state, and federal regulations. Ability to take initiative and meet deadlines. Ability to exercise sound judgment and maintain objectivity and integrity throughout the audit process. Proficient use of Microsoft Office 365 suite, particularly SharePoint, Visio, Excel, and Microsoft Project. Ability to effectively use audit software and tools, such as ACL, IDEA, or Excel, to perform data analysis and audit testing. Exceptional written and verbal communication skills to clearly articulate audit findings, recommendations, and reports to diverse audiences, including senior leadership. Maintain attendance to support required quality and quantity of work. Maintain positive and effective work relationships with coworkers, clients, members, providers and customers. Other duties as assigned. Qualifications Minimum Experience: Bachelor's Degree (higher degree accepted) in accounting, finance, public administration, business or related field Minimum Experience: 7 years Progressive and comprehensive audit experience, preferably in internal audit or public accounting

This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer 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 medical staff department to identify and assist providers with coding. Report findings and recommendations to compliance and executive leadership. Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding. Support compliance policies with government (Medicare & Medicaid) and private payer regulations. Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, 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. Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with department personnel to provide coding/compliance support. Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines. Perform other duties as assigned. Knowledge, Skills and Abilities: Proficiency in correct application of CPT, HCPCS procedure and ICD-10-CM diagnosis codes used for coding and billing for medical claims. High Knowledge of medical terminology, disease processes and pharmacology. Strong attention to detail and accuracy. Excellent verbal, written and communication skills. Ability to multi-task. Excellent organizational skills. Proficient in Microsoft Office Suite. Critical thinking/problem solving. Ability to provide data and recommend process improvement practices. Qualifications Education: High School Diploma or equivalent (higher degree accepted) with 5 years of experience Associates Degree (higher degree accepted) Licenses/Certifications: Certified Professional Coder (CPC ) through AAPC OR Certified Coding Specialist (CCS ) through American Health Information Management Association (AHIMA) required. Required Work Experience: 5 years Experience in a medical office or medical environment. 5 years Experience in procedural and diagnostic coding. 5 years Extensive knowledge of current trends in the industry based on Medicare and Texas Medicaid as well as national coding updates, such as AMA correct coding, nationally recognized coding references and/or appropriate list serves. 5 years Extensive knowledge of Centers for Medicare & Medicaid (CMS) regulations.

The CLIA MA Auditor supports clinical quality and regulatory compliance by conducting audits and providing oversight related to CLIA-waived testing and MA-performed procedures across health center outpatient sites. This role ensures that clinical staff performing testing adhere to CLIA standards, organizational protocols, and regulatory requirements. The auditor collaborates with nursing leadership, laboratory services, infection prevention and quality departments to assess practices, deliver targeted training, and prepare clinics for inspections. Responsibilities Essential Functions * Schedule and perform site audits to monitor compliance with CLIA regulations, policies, and procedures, especially regarding CLIA-waived point-of-care testing performed in outpatient settings. * Review training records, competency assessments, and documentation for CLIA-waived testing. * Identify gaps in practice or documentation and recommend corrective actions. * Conduct follow-up audits and partner with site leads to ensure ongoing compliance. * Maintain up-to-date knowledge of CLIA, OSHA, and relevant federal and state regulations. * Maintain up to date knowledge of waived testing instructions for use and associated instrumentation. * Provide education and training to MAs and site leaders on CLIA standards and documentation protocols. * Collaborate with lab services and nursing quality teams to align audits with organizational initiatives. * Aid in transition of sites to updated processes and documentation related to CLIA-waived testing. * Assist in preparing sites for inspections and accreditation readiness. * Maintain accurate audit logs, reports, and records for regulatory review. * Review audit findings with clinical leadership and contribute to quality control projects. Qualifications Minimum Education: High School Diploma or equivalent (higher degree accepted) Graduate of an accrediated Medical Asssitant Program Minimum Experience: 3+ years of clinical experience as a Medical Assistant, including CLIA-waived testing Required Certifications/Licenses: Certified or Registered Medical Assistant (CMA or RMA) Point of Care Specialist Certificate Program completion required or must be obtained within 18 months of holding the position, or equivalent

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. Seeking an Information Technology auditor with 2+ years of experience executing assessments/audits related to Information Technology (IT), Cybersecurity, and Emerging Digital competencies. A relevant certification is highly preferred. **A caregiver in this role works days from 8:00 a.m. - 5:00 p.m.** **_This is a hybrid position requiring local residency in the Cleveland area, with three days remote and two days on-site at West Creek Independence._** A caregiver who excels in this role will: + Plan, perform and evaluate internal audits. + Leverage agile methodology concepts in executing procedures. + Help identify control improvements in response to enterprise IT/Cybersecurity risks. The ideal future caregiver is someone who: + Can complete IT audit and advisory procedures for assigned projects efficiently, including testing the effectiveness of internal controls and/or adherence to policy/requirements. + Demonstrates critical thinking skills, decisive judgement, and can work both collaboratively and independently. + Effectively documents applicable I.T. and cyber audit and advisory findings, including recommendations for improving controls and complying with regulatory requirements. + Can manage multiple priorities and projects with competing priorities at once. + Has general business knowledge of IT/Cybersecurity concepts, including familiarity with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule/concepts and/or National Institute of Standards and Technology (NIST) Cybersecurity Framework. By taking this opportunity, you will add value to all areas of Cleveland Clinic and make meaningful impacts to help our patients, community, organization and caregivers. This collaborative team also offers 40 hours of education/training (for candidates with a certification) and works a required hybrid work schedule. At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare. Responsibilities: + Under general supervision, completes assignments relating to IT audits or advisory projects. + Plans and conducts audit and advisory tests and procedures designed to evaluate the adequacy and effectiveness of controls for safeguarding Cleveland Clinic data and assets. + Effectively collects and analyzes data from diverse sources, including utilizing computer-assisted auditing techniques, and coordinates documentation requests and clarifying questions with internal stakeholders. + Ability to select samples and generate clear and concise supporting documentation results against defined attributes. + Prepares and maintains complete and accurate support documentation in response to assigned auditing and advisory activities. + Documents applicable audit and advisory findings, including recommendations for improving controls and complying with regulatory requirements. + Assures appropriate completion of assignments; tracks time and organizes electronic audit and advisory documentation using applicable department software. + Manages multiple priorities and projects with competing priorities. + Acts as an internal resource to enhance awareness and understanding of leading practices, risk management and use of controls by management. + Maintains current and proficient knowledge of applicable federal, state, and local laws, regulations, policies, and procedures. + Complies with the Institute of Internal Auditors (IIA) Global Audit Standards. + Other duties as assigned. Minimum qualifications for the ideal future caregiver include: + Bachelor's of Science or BBA degree with specialization in Accounting, Business Administration, or related field + Working knowledge of information systems concepts and controls + Consulting or tech consulting background or support area + Knowledge of common cybersecurity frameworks, controls Preferred qualifications for the ideal future caregiver include: + Advanced degree + Two years of professional andfunctionally relevant information technology or cybersecurity experience. + Technology and Cybersecurity technical experience + Internal Audit experience + Hands-on experience with cybersecurity auditing, assessment, or consulting + Proficient with Microsoft Office tools (Excel, Word, PowerPoint and Teams) + Experience translating complex technical content into clear action items or presentations + Familiarity with common cybersecurity frameworks, controls, and terminology (e.g. CISA, CISSP concepts) Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we're dedicated to providing what matters most to you: ******************************************** **Physical Requirements:** + Requires walking to various locations on campus as well as travel to off-campus sites. + Requires dexterity sufficient to operate a PC computer in the course of work. **Personal Protective Equipment:** + Follows standard precautions using personal protective equipment as required. **Pay Range** Minimum Annual Salary: $57,510.00 Maximum Annual Salary: $87,697.50 The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic's benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.). Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities

Right at Home is looking for an experienced Franchise Royalty Auditor! In this position you will be contributing to the accuracy, completeness, and contractual compliance of franchisee royalty revenue across all RiseMark brands. This involves auditing financial data, reconciling systems, and supporting cross-functional efforts to maintain integrity in royalty reporting and franchisee communications. Do you achieve goals consistently and efficiently? Are you someone who works thoroughly, leaving nothing to chance? Do you bring accountability to work? If you answered YES to the questions above... keep reading and apply today! Right at Home is clear in its mission... "To improve the quality of life for those we serve" . You can help us achieve this mission by lending your leadership experience, proactive problem-solving abilities, success in small business and effecting coaching skills to our organization! When you come and work for Right at Home, you are joining a company that values its employees in all aspects of life. We offer a casual work environment, hybrid work availability, flexible time off, parental leave, competitive pay, and so many other great benefits! We are protective of our culture and enjoy working with others who share our core values: Authentic, Accountable, Approachable, Collaborate and Integrity ! We aspire to work with colleagues who Get it, Want it and have the Capacity to do it. That means you'll work with people who know what it takes to succeed, strive for excellence and have the skills and knowledge necessary to get the job done right! We use the EOS approach to our business, creating transparency and accountability. Primary Responsibilities: Consistently upholds and demonstrates the Right at Home core values: Authentic, Accountable, Collaborative, Integrity and Approachable Review and interpret franchise agreements to ensure that royalty and brand fund payments are calculated correctly according to contractual terms and rates Analyze financial data, sales reports, and royalty statements to identify discrepancies, errors or potential underpayments Reconcile royalty revenue between multiple software systems Collaborate with cross-functional teams to support contract negotiations and amendments Communicate with franchisees/customers regarding audit findings and establish repayment terms Maintain detailed documentation of audit findings and prepare reports for management Assist in the development and implementation of royalty tracking systems and process improvements Support franchisee compliance audits Support external audits and regulatory compliance efforts related to royalty revenue Participate in special projects and perform other duties as assigned Successful candidates will have: Bachelor's Degree in Accounting Certified Public Accountant (CPA) designation preferred 3+ years of successful experience in financial statement, revenue or royalty auditing Strong understanding of royalty structures, licensing agreements, and revenue recognition principles Strong understanding of auditing principles and practices Proficiency in Excel and financial systems Successful use of project management principles Excellent analytical skills and attention to detail Demonstrated ability to work positively within cross-functional teams and external parties Excellent verbal and written communication skills Ability to prioritize work, multi-task, and meet established deadlines Ability to adapt to change in a fast-paced environment Right at Home, a RiseMark Holdings, LLC company, is an equal opportunity employer that celebrates, supports and promotes diversity and inclusion. We will consider all qualified applicants without regard to race, color, religion, sex, national origin, disability, protected veteran status, sexual orientation or gender identity, or any other legally protected basis, in accordance with applicable law. INDCORP

Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all. The Compliance Auditor supports Marin Community Clinics' compliance, risk management, and quality programs by performing independent audits, monitoring activities, and data validation to ensure adherence to federal and state regulations. This includes HRSA Health Center Program requirements, FTCA, CMS billing and documentation rules, Medi-Cal, TJC standards, HIPAA/HITECH, 42 CFR Part 2, California health laws, and internal policies. The role works closely with clinical, operational, billing, dental, behavioral health, specialty, and administrative teams to identify gaps, validate corrective actions, ensure MCC is audit ready, and ensure continuous improvement in compliance, quality, and patient safety. Responsibilities Compliance Auditing & Monitoring * Conduct audits across medical, dental, behavioral health, specialty, and billing workflows. * Evaluate documentation, coding, billing accuracy, and alignment with CMS, Medi-Cal, and HRSA requirements. * Audit privacy/security compliance (HIPAA, HITECH, 42 CFR Part 2), telehealth consent, and minimum necessary requirements. * Perform FTCA-related audits, including credentialing/privileging, QI, incident reporting, and OB risk processes. * Review compliance with TJC standards and adherence to California laws and regulations. Regulatory & Policy Compliance * Audit adherence to internal policies, workflows, and operational procedures. * Incorporate regulatory updates (OIG, CMS, HRSA, and California) into audit tools. * Support HRSA Site Visit Protocol (SVP) monitoring. Data Review & Reporting * Develop audit tools and sampling methodologies. * Produce clear audit reports outlining findings, trends, risk levels, and recommendations. * Present results to leadership and committees; track corrective actions. Risk Identification & Mitigation * Identify regulatory, financial, operational, and clinical risks and escalate issues appropriately. * Recommend corrective action that support Just Culture and patient safety. * Participate in root cause analysis (RCA) and after-action reviews. Training, Education & Technical Support * Provide targeted feedback and education based on audit findings. * Support development of compliance training modules and department workflows. Continuous Quality Improvement * Validate quality measure documentation (UDS, HEDIS, CalAIM, dental and behavioral health metrics) and workflow adherence. * Support performance improvement plans and monitor sustainability. Additional Duties * Maintain audit logs, dashboards, CAP tracking, and trend reports. * Support compliance hotline review, investigations, and regulatory survey preparation (HRSA, OSV, TJC, FTCA, CDPH, payer audits, etc). * Participate in cross-functional meetings as needed. * Additional duties as assigned. Supervisory Responsibilities: * n/a Qualifications Education * Bachelor's degree education in health-care administration, health information management or law is required. * Master's degree level in related field is preferred. * Relevant professional certifications a plus. Experience * Minimum 2-4 years of experience in health-care compliance, coding/billing auditing, documentation review, or quality improvement. * FQHC, ambulatory care setting, or multisite clinic environment strongly preferred. * Working knowledge of Medi-Cal, CMS, HRSA, FTCA, and CA-specific health-care regulations. Certifications (Preferred) * Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) * Certified in Healthcare Compliance (CHC), or equivalent * Dental coding certification a plus * QI, risk management, or safety certification is a plus Required Skills and Abilities * Strong understanding of HIPAA, HITECH, 42 CFR Part 2, CMS Billing Guidelines, Medi-Cal requirements, Cal/OSHA, and TJC standards. * Coding knowledge (ICD-10, CPT, HCPCS, CDT, DSM-5). * Excellent analytical, critical thinking, communication, and report-writing skills. * Ability to manage multiple audits simultaneously. * Ability to maintain confidentiality and professionalism at all times. * Proficiency using EHRs (Epic, eCW, Dentrix, etc.), audit tools, spreadsheets, and dashboards. Physical Requirements and Working Conditions * Fulfill Immunization and fit for duty regulatory requirements. * Office and clinic-based; travel required between sites. * Occasional evening / morning hours for audits or meetings. * Ability to sit, stand, and walk for extended periods. * Ability to lift up to 20 lbs. Benefits: Our benefits program is designed to protect your health, family and way of life. We offer a competitive Benefits Program that includes affordable health insurance and Health Reimbursement Accounts (HRA), Dental and Vision Insurance, Educational and Continuing Education Benefits, Student Loan Repayment and Loan Forgiveness, Retirement Plan, Group Life and AD&D Insurance, Short term and Long Term Disability benefits, Professional Fee Reimbursement, Mileage and Cell Phone Reimbursement, Scrubs Reimbursement, Loupes Reimbursement, Employee Assistance Programs, Paid Holidays, Personal Days of Celebration, Paid time off, and Extended Illness Benefits. Marin Community Clinics is an Equal Employment Opportunity Employer. Min Max

OBJECTIVE: Act as main point of contact for all Asset Facility Audits. Take pictures to support all documented remarks both good and bad to make owners aware of asset condition. Generate reports to include recommendations for corrective action and/or correct potential loss exposures identified. ESSENTIAL FUNCTIONS (other duties as assigned) Conduct one Asset Facility Audit at all PIPESTONE farms annually. Work by oneself and be self-motivated, self-reliable and trustworthy. Write a work schedule that is flexible, effective, and efficient. Inspecting facilities from subgrade to roofing system and noting condition of all key points within on specified asset audit document. Taking digital pictures to support all documented remarks both good and bad with key focus on any necessary recommendations to make owners aware of asset condition Generate reports with information necessary to include recommendations for corrective action and/or correct potential loss into Maintenance Connection and ensure photos with documents are shared with proper team members - self follow up, PRM, PRM project team Estimate timeline for action needed: 1 = within 1 year 2 = 2-3 years 3 = 4-5 years Cost estimates: 1 = 1 estimate backed by previous data 2 = rough estimate 3 = ball park numbers Write a detailed and a summary report for each audit and email them to the following people: PRM Items: Email to PRM Administrative Assistant. Cc: Director of Air Filtration and Ventilation, PRM Director, PRM Supervisor, VP of Asset Management. Detailed Report: Farm Manager, Farm Production Supervisor, Regional Production Director, Regional VP of Production, Director of Ventilation and Air Filtration, PRM Director, PRM Supervisor, VP of Asset Management, Executive VP of Pipestone Management. Summary Report for Shareholder Presentation: Director of Air Filtration and Ventilation, VP of Asset Management, Executive VP of Pipestone Management. Once approved by this group, email the summary to the Relationship Manager and the Shareholder Communication Coordinator. Meet and interact with fellow employees/farm managers/supervisors and contractors. Complete appropriate electronic documentation related to auditing, including timecards, service requests, mileage logs, credit card/expense reports and emails. POSITION SPECIFICATIONS Education: B.S. degree with an agricultural or construction management focus preferred Experience: 3 to 4 years construction/maintenance experience or post-secondary education/training in these fields may be substituted for B.S. degree Work Environment: Agricultural swine environment in rural area Office/hybrid ability Physical Requirements: Standing, walking and ability to be on feet 8 to 10 hours per day Frequent bending, reaching, squatting and kneeling Frequent use of one or both hands/arms to grasp or pull Frequent lifting of objects weighing 3-20 pounds Occasional bending while pulling and/or lifting objects weighing up to 50 pounds, or requiring up to 50 pounds of force to move Ability to climb ladders and stairways Able to work within the atmosphere inside and outside a swine confinement barn Ability to work in temperatures ranging from +100 degrees F to subzero Ability to attend and participate in meetings of various lengths Additional Requirements: Must have valid driver's license and reliable transportation to get to work and attend meetings Overnight travel required Compensation, Pay & Benefits: $70,000-$95,000 base salary, depending on experience Benefit Package includes Paid Single Health Insurance, Family Health Coverage Available Dental/Vision/Life/Disability Insurance Retirement Plan Holidays & Paid Time Off

We are seeking a detail-oriented and analytical Auditor to join our team, with a focus on reviewing managed care claims to ensure billing accuracy, compliance with payer contracts, and identification of fraud, waste, or abuse. This role involves deep dives into claims data, provider billing patterns, and contract terms to identify discrepancies and recommend corrective actions. Duties: * Conduct audits of managed care claims to verify accuracy, appropriateness, and adherence to contractual and regulatory requirements. * Identify billing anomalies, upcoding, unbundling, duplicate billing, or other indicators of fraud, waste, or abuse. * Analyze claim data using audit software and data analytics tools (e.g., Excel, SAS, SQL, Power BI). * Review and interpret managed care contracts, payer policies, fee schedules, and medical records as needed to support audit findings. * Prepare detailed reports with findings, supporting documentation, financial impact, and recommended corrective actions. * Collaborate with internal departments (billing, coding, compliance, legal) and external stakeholders (payers, providers) to resolve discrepancies. * Stay current with industry regulations, CMS guidelines, and payer-specific billing requirements. * Support investigations of potential fraud or overpayment recovery efforts. * Assist in the development of audit methodologies, risk assessments, and process improvement initiatives. JOB QUALIFICATIONS Minimum Education (Indicate minimum education or degree required.) * Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field. Preferred Education (Indicate preferred education or degree required.) * N/A Minimum Work Experience and Qualifications (Indicate minimum years of job experience, skills or abilities required for the job.) * Minimum of 5 years of experience in forensic auditing, healthcare claims auditing, or managed care analytics. * Strong working knowledge of managed care claims processing, CPT/HCPCS/ICD-10 coding, and payer reimbursement methodologies. * Familiarity with MediCal, Medicare, and commercial insurance guidelines. * Proficient in data analysis tools (e.g., Excel, Access, SQL, audit software). * Exceptional attention to detail and analytical thinking. * Strong written and verbal communication skills, with the ability to present findings to both technical and non-technical audiences. * Ability to manage multiple priorities in a deadline-driven environment. Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.) * Certified Fraud Examiner (CFE), Certified Internal Auditor (CIA), or similar certification. * Prior experience at a Management Service Organization (MSO) of Health plan a plus * Experience working with healthcare auditing platforms or tools (e.g., Truven, Minitab, RAC tools). * Background in healthcare compliance or legal investigations related to claims a plus. Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.) * Current Los Angeles County Fire Card (or must be obtained within 30 days of hire) * Assault Response Competency (ARC) required (within 30 days of hire) Full-Time, Exempt