Auditor jobs at Humana

Option to be Hybrid/Remote. A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic's policies and procedures and accepted guidelines for medical coding. Works closely with the Compliance Officer and Compliance coding Audit Coordinator to perform audits outlined in the work plan. Requires ability to present detailed analysis of audits in both written and spoken form. Relies on professional judgement to ensure Internal Audit and Compliance standards are used to assess compliance with CPT, ICD-9/10, HCPCS, Payor, CMS guidelines and TGC policies Experience: - Working knowledge of medical terminology, anatomy and physiology, and coding guidelines including CPT, ICD- 9 /10-CM, and HCPCS coding systems and guidelines, payer guidelines and requirements. - Minimum 1-year experience in Physician coding and billing and/or compliance field required 5 year of clinical experience and/or knowledge and understanding of Medical Records auditing process preferred. - Required to sit for CPC exam within one year. Education: - Associates degree required; Bachelor's preferred Licenses/Certifications: - AHIMA (RHIA, RHIT, or CCS) or AAPC (CPC) required - RN/LPN or CPMA preferred - Required to sit for CPC exam within one year Essential Functions: 1. Conducts auditing for accuracy of coding, leveling, and provider documentation in compliance with accepted guidelines (federal, state, local, and insurance regulations as well as The Guthrie Clinic policies, as applicable, Medicare, Medicaid, and LCD (Local Coverage Determinations), and NCD (National Coverage Determinations), insurance companies) 2. Performs, and reports coding audits based on the Internal Audit and Compliance Work Plan including completing other special auditing projects as requested, communicating audit findings by preparing final reports and discussing findings with providers and/or staff, as appropriate, and maintaining excellent documentation of all reviews, methodologies employed, results, corrective actions implemented, and monitoring 3. Complete and submit external audits that come from state and federal agencies including coordinating with the appropriate departments to gather required documentation requested from the agencies and ensure timely submissions, as well as communicating external audit findings with senior leadership, providers and/or staff, as appropriate 4. Assists in educating and training providers and staff in relation to coding, billing and compliance issues 5. Assists in developing annual work plan based on identified external and internal risks. Audits include OIG, OMIG - New York, LCD (Local Coverage Determinations), and NCD (National Coverage Determinations), performing Internal risk assessments, and reviews past audit insufficiencies or reports of non-compliance 6. Maintains professional and technical job knowledge by participating in educational opportunities, reading professional publications, establishing, and maintaining personal networks, and participating in professional organizations 7. Enhances compliance department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments 8. Work closely with internal billing and reimbursement departments to ensure internal processes are understood 9. Maintains knowledge and proficiency in the Epic EMR, PARC, HIM/ROI, and Microsoft Office as needed 10. Communicates the results of compliance reviews/audits with all parties involved to ensure understanding of outcomes and any need for corrective actions. 11. Research risk areas and compliance concerns related to coding and payer requirements and provides analysis to Compliance Officers or management as required. 12. Research legislation, standards, and policies related to HIPAA privacy and security regulations and provides analysis to Compliance Officers or management as required 13. Maintains excellent documentation of all reviews, methodologies employed, results, corrective actions implemented, and monitoring through departmental workplan Other Duties: 1. Travel for this position is sometimes required. 2. Participation in community and employee engagement activities is required. 3. It is understood that this description is not intended to be all-inclusive and that other duties may be assigned as necessary in the performance of this position. Rev: 7-2-2024

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)

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)

At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. The mission of the STERIS Quality & Regulatory Compliance function is to implement repeatable and sustainable processes to ensure on-going compliance with domestic and international regulations and standards. This includes evaluating the relevance to all STERIS facilities and products and implementing efficient and effective processes to ensure adherence to applicable regulations and standards. * This is a hybrid role based in STERIS' Corporate Offices in Mentor, Ohio. In order to support the business needs working a minimum of 3 days a week in the Mentor office is expected. * 20% domestic and international travel required What you'll do as an Lead, Quality & Regulatory Compliance Auditor * Lead internal quality audits to assess compliance of a facility's quality management system with applicable US and international standards, regulatory requirements, and Corporate and local procedures, policies, and work instructions. Conduct internal audits using good time management practices to maximize efficiency. * Draft internal audit reports to clearly communicate audit findings and recommendations for compliance improvements. * Address and resolve any differences in viewpoints in a positive manner with a focus on continuous improvement and business efficiency while maintaining compliance. * Train developing auditors to support the internal quality auditing activity. * Support execution of the supplier quality audit program, including, qualifications and/or audits, routine monitoring, assessment meetings, action requests, and as necessary, issue resolution. * Provide support to the Quality & Regulatory Compliance team in the investigation and resolution of audit observations * Review corrective action activities for audit observations and obtain and review objective evidence as actions * are completed in accordance with prescribed commitments. * Lead and support the Quality Operations team in supporting key objectives, trending, and process * improvement. The Experience, Skills and Abilities Needed Required: * Four (4) year degree required, preferably with general business core, risk management, project management, regulatory, or internal audit * Minimum of four (4) years professional experience, preferably including regulatory affairs, legal, governmental compliance, quality systems, or internal auditing. * 25% travel required (domestic & international). Preferred: * Leadership / people management experience preferred. * Experience in the medical device industry is a plus. * Professional certifications and regulatory training certificates in relevant disciplines are desirable, as is completion of or actively working towards an advanced degree in a relevant discipline. * Bilingual skills are a plus, but not required. Skills: * Provide support to Quality & Regulatory Compliance department management as requested during the development of Senior Management and Compliance Committee presentation materials or special projects. * Conduct yourself in accordance with the principles of the STERIS Code of Business Conduct and comply with all Company policies. * Protect company confidential information by properly storing, retrieving, and disseminating such information only to those authorized. * Conduct daily activities of job responsibilities and projects as assigned. * Support a safe, clean, and secure working environment by supporting procedures, rules, and regulations. * Demonstrated experience in effectively leading quality audits. * Demonstrated ability to balance multiple high priority responsibilities on-time and effectively. * Self-starter with demonstrated organizational, project management, time management, and problem-solving skills. * Can comfortably and effectively confront difficult situations and issues in a timely and appropriate manner. * Strong interpersonal skills - ability to work closely with people at all levels within the STERIS organization and facilitate the implementation of corrective actions; able to work effectively and professionally with external people including suppliers. * Strong oral and written communication skills. * Excellent PC skills, including Microsoft Office applications, and the use of AI tools. Additionally, the Lead, Quality and Regulatory Compliance Auditor must have expert working knowledge of the following regulations and standards: * 21 CFR Part 820 -Quality Management System Regulations (QMSR) * 21 CFR Part 803 - Medical Device Reporting * 21 CFR Part 806 - Reports of Corrections and Removals * 21 CFR Part 7 - Enforcement Policy, Subpart C - Recalls * 21 CFR Part 211 - Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) * 21 CFR Part 11 - Electronic Records, Electronic Signatures * ISO 13485 Medical devices - Quality management systems * ISO 9001 Quality management systems - Requirements * EN ISO 11135-1 Sterilization of healthcare products - Ethylene Oxide * EN ISO 11137-1 Sterilization of healthcare products - Radiation * ISO/IEC 17025 General requirements for the competence of testing and calibration laboratories * ISO 14971 Application of Risk Management to Medical Devices * EU Medical Device Directive * EU Medical Device Regulation The compliance activities require close work with STERIS corporate domestic and international staff and Customers and U.S and foreign government agencies. What STERIS Offers We value our employees and are committed to providing a comprehensive benefits package that supports your health, well-being and financial future. Here is a brief overview of what we offer: * Market Competitive Pay * Extensive Paid Time Off and (9) added Holidays * Excellent Healthcare, Dental and Vision Benefits * Long/Short Term Disability Coverage * 401(k) with a company match * Maternity and Paternity Leave * Additional add-on benefits/discounts for programs such as Pet Insurance * Tuition Reimbursement and continued education programs * Excellent opportunities for advancement in a stable long-term care #LI-SA2 #ZRSA-1 #LI-Hybrid Pay range for this opportunity is $78,200.00 - $95,000. This position is eligible for bonus participation. Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc. STERIS offers a comprehensive and competitive benefits portfolio. Click here for a complete list of benefits: STERIS Benefits Open until position is filled. STERIS is a leading global provider of products and services that support patient care with an emphasis on infection prevention. WE HELP OUR CUSTOMERS CREATE A HEALTHIER AND SAFER WORLD by providing innovative healthcare and life sciences products and services around the globe. For more information, visit *************** If you need assistance completing the application process, please call ****************. This contact information is for accommodation inquiries only and cannot be used to check application status. STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity. The full affirmative action program, absent the data metrics required by § 60-741.44(k), shall be available to all employees and applicants for employment for inspection upon request. The program may be obtained at your location's HR Office during normal business hours.

At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. The mission of the STERIS Quality & Regulatory Compliance function is to implement repeatable and sustainable processes to ensure on-going compliance with domestic and international regulations and standards. This includes evaluating the relevance to all STERIS facilities and products and implementing efficient and effective processes to ensure adherence to applicable regulations and standards. This is a hybrid role based in STERIS' Corporate Offices in Mentor, Ohio. In order to support the business needs working a minimum of 3 days a week in the Mentor office is expected. 20% domestic and international travel required What you'll do as an Lead, Quality & Regulatory Compliance Auditor Lead internal quality audits to assess compliance of a facility's quality management system with applicable US and international standards, regulatory requirements, and Corporate and local procedures, policies, and work instructions. Conduct internal audits using good time management practices to maximize efficiency. Draft internal audit reports to clearly communicate audit findings and recommendations for compliance improvements. Address and resolve any differences in viewpoints in a positive manner with a focus on continuous improvement and business efficiency while maintaining compliance. Train developing auditors to support the internal quality auditing activity. Support execution of the supplier quality audit program, including, qualifications and/or audits, routine monitoring, assessment meetings, action requests, and as necessary, issue resolution. Provide support to the Quality & Regulatory Compliance team in the investigation and resolution of audit observations Review corrective action activities for audit observations and obtain and review objective evidence as actions are completed in accordance with prescribed commitments. Lead and support the Quality Operations team in supporting key objectives, trending, and process improvement. The Experience, Skills and Abilities Needed Required: Four (4) year degree required, preferably with general business core, risk management, project management, regulatory, or internal audit Minimum of four (4) years professional experience, preferably including regulatory affairs, legal, governmental compliance, quality systems, or internal auditing. 25% travel required (domestic & international). Preferred: Leadership / people management experience preferred. Experience in the medical device industry is a plus. Professional certifications and regulatory training certificates in relevant disciplines are desirable, as is completion of or actively working towards an advanced degree in a relevant discipline. Bilingual skills are a plus, but not required. Skills: Provide support to Quality & Regulatory Compliance department management as requested during the development of Senior Management and Compliance Committee presentation materials or special projects. Conduct yourself in accordance with the principles of the STERIS Code of Business Conduct and comply with all Company policies. Protect company confidential information by properly storing, retrieving, and disseminating such information only to those authorized. Conduct daily activities of job responsibilities and projects as assigned. Support a safe, clean, and secure working environment by supporting procedures, rules, and regulations. Demonstrated experience in effectively leading quality audits. Demonstrated ability to balance multiple high priority responsibilities on-time and effectively. Self-starter with demonstrated organizational, project management, time management, and problem-solving skills. Can comfortably and effectively confront difficult situations and issues in a timely and appropriate manner. Strong interpersonal skills - ability to work closely with people at all levels within the STERIS organization and facilitate the implementation of corrective actions; able to work effectively and professionally with external people including suppliers. Strong oral and written communication skills. Excellent PC skills, including Microsoft Office applications, and the use of AI tools. Additionally, the Lead, Quality and Regulatory Compliance Auditor must have expert working knowledge of the following regulations and standards: 21 CFR Part 820 -Quality Management System Regulations (QMSR) 21 CFR Part 803 - Medical Device Reporting 21 CFR Part 806 - Reports of Corrections and Removals 21 CFR Part 7 - Enforcement Policy, Subpart C - Recalls 21 CFR Part 211 - Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) 21 CFR Part 11 - Electronic Records, Electronic Signatures ISO 13485 Medical devices - Quality management systems ISO 9001 Quality management systems - Requirements EN ISO 11135-1 Sterilization of healthcare products - Ethylene Oxide EN ISO 11137-1 Sterilization of healthcare products - Radiation ISO/IEC 17025 General requirements for the competence of testing and calibration laboratories ISO 14971 Application of Risk Management to Medical Devices EU Medical Device Directive EU Medical Device Regulation The compliance activities require close work with STERIS corporate domestic and international staff and Customers and U.S and foreign government agencies. What STERIS Offers We value our employees and are committed to providing a comprehensive benefits package that supports your health, well-being and financial future. Here is a brief overview of what we offer: Market Competitive Pay Extensive Paid Time Off and (9) added Holidays Excellent Healthcare, Dental and Vision Benefits Long/Short Term Disability Coverage 401(k) with a company match Maternity and Paternity Leave Additional add-on benefits/discounts for programs such as Pet Insurance Tuition Reimbursement and continued education programs Excellent opportunities for advancement in a stable long-term care #LI-SA2 #ZRSA-1 #LI-Hybrid Pay range for this opportunity is $78,200.00 - $95,000. This position is eligible for bonus participation. Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc. STERIS offers a comprehensive and competitive benefits portfolio. Click here for a complete list of benefits: STERIS Benefits Open until position is filled. STERIS is a leading global provider of products and services that support patient care with an emphasis on infection prevention. WE HELP OUR CUSTOMERS CREATE A HEALTHIER AND SAFER WORLD by providing innovative healthcare and life sciences products and services around the globe. For more information, visit *************** If you need assistance completing the application process, please call ****************. This contact information is for accommodation inquiries only and cannot be used to check application status. STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity. The full affirmative action program, absent the data metrics required by § 60-741.44(k), shall be available to all employees and applicants for employment for inspection upon request. The program may be obtained at your location's HR Office during normal business hours.

Job Details ChristianaCare is searching for a Compliance Auditor to support the Office of Compliance & Privacy through assigned compliance activities and audits to ensure effective clinical documentation that meets regulatory guidelines. The Compliance Auditor performs a variety of audits to investigate and monitor compliance with federal and state laws, as well as Centers for Medicare and Medicaid Services (CMS) regulations, billing, coding and medical necessity documentation guidelines, and HIPAA Privacy standards. They perform financial, operational and compliance audits for the Office of Compliance & Privacy. Work is diverse and assignments could include a wide array of business areas such as inpatient and outpatient services, physician practices, and contracts. An individual with clinical/medical necessity expertise is preferred. The successful candidate must have clinical chart review experience, in addition to broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, and medical necessity criteria. Education and experience requirements: * Bachelor's Degree is required. * Equivalent of 5+ years' experience in nursing, compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or compliance department operations/regulations * Certification (at least one of the following are required and are to be maintained as a condition of employment) * Certified in Healthcare Compliance (CHC); Certified in Healthcare Privacy Compliance (CHPC) * In-depth knowledge of compliance and privacy regulations * Must be proficient in CMS Conditions of Participation, CMS Conditions of Payment, and Inpatient and Outpatient Prospective Payment System. Strong analytical and communication skills. * Candidates who do not hold a CHC will be given consideration but will need to obtain the CHC within 2 years of their hire date with the company. * Experience in compliance and privacy auditing techniques and methods preferred, but not required Principal duties and responsibilities: * Helps the Office of Compliance & Privacy adhere to assigned audit schedule and reviews as outlined in the Departmental Compliance Workplan and as assigned * Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests. * Conducts audits and focused reviews to ensure compliance with government and payor guidelines. * Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting. * Reviews documentation to ensure appropriate assignment of facility-based and provider-based clinical documentation and medical necessity, * Maintain a working knowledge of HIPAA and CMS regulations. * Participate in the planning and scheduling of compliance projects. * Research compliance related questions upon request from departments and/or practices. * Identify and report potential audit and compliance risks. Special requirements: Must maintain current CCB certification When you become an employee at ChristianaCare, you are joining a robust healthcare organization that truly cares about their patients and their caregivers. For the second consecutive year, Forbes magazine has ranked ChristianaCare as one of the best large health systems to work for in the United States! Guided by excellence and love, our Caregivers enjoy a multitude of employee benefits that include: * Full Medical, Dental, Vision and other insurance benefits * 403 (b) with an employer match * Diverse and Inclusive culture * Generous paid time off with annual roll-over and opportunities to cash out * 12 week paid parental leave About Christiana Care: Headquartered in Wilmington, Delaware, ChristianaCare is one of the country's most dynamic health systems, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, two hospitals (1,227 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women's health. ChristianaCare is a not-for-profit teaching health system with more than 260 residents and fellows. We are continually ranked by US News & World Report as a Best Hospital. With our unique, data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care. Annual Compensation Range $68,161.60 - $109,054.40 This pay rate/range represents ChristianaCare's good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law. Post End Date Jan 10, 2026 EEO Posting Statement ChristianaCare offers a competitive suite of employee benefits to maximize the wellness of you and your family, including health insurance, paid time off, retirement, an employee assistance program. To learn more about our benefits for eligible positions visit *********************************************************

Department: Compliance Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:00:00 AM Minimum to Midpoint Pay Rate:$33.37 - $45.05 / hour The Compliance Auditor will assist in the overall compliance audit and investigative activities to ensure organizational compliance with applicable laws, regulations, and standards of conduct. This person will conduct planned audits, probe audits, chart reviews and contribute to the annual Compliance risk assessment. The Compliance Auditor will also verify reimbursement and/or coding when appropriate. The Compliance Auditor will help complete compliance work plans and provide staff education and internal guidance to operational departments. This person also will investigate compliance and ethical concerns, such as reports of fraud, waste, and abuse. This position will have a hybrid schedule. Requirements Educational Requirements Degree/Diploma ObtainedProgram of StudyRequired/ Preferredand/or AssociatesNursingRequiredorBachelorNursingPreferredand Additional Requirements Experience Requirements Minimum Years RequiredArea of ExperienceRequired/ Preferredand/or5 YearsClinicalRequired Additional Requirements Five years of clinical experience and knowledge of health system operations. Prior regulatory compliance or audit experience preferred. State of Florida Licensure Requirements LicensesRequired/ Preferredand/or Registered Nurse LicenseRequired Certifications/Registration Requirements Certificates/RegistrationsRequired/ Preferredand/or Additional Requirements Coding Certification (CCA, CCS, CCS-P, CPC,or CPC-H) required within one (1) year of hire. Compliance certification (CHC) required within two (2) years of hire. Other Requirements Critical thinking, strong research skills and knowledge of clinical quality concepts, medical necessity, clinical documentation, and medical terminology. Knowledgeable in compliance-oriented tasks including reviewing coverage determinations, Medicare materials, final rules, regulations, and organizational policies, preferred. Ability to handle multiple tasks and demonstrate good communication skills preferred. Proficient in the use of Microsoft Office programs and reporting applications preferred. US:FL:Fort Myers

This is where your work makes a difference. At Baxter, we believe every person-regardless of who they are or where they are from-deserves a chance to live a healthy life. It was our founding belief in 1931 and continues to be our guiding principle. We are redefining healthcare delivery to make a greater impact today, tomorrow, and beyond. Our Baxter colleagues are united by our Mission to Save and Sustain Lives. Together, our community is driven by a culture of courage, trust, and collaboration. Every individual is empowered to take ownership and make a meaningful impact. We strive for efficient and effective operations, and we hold each other accountable for delivering exceptional results. Here, you will find more than just a job-you will find purpose and pride. Your Role at Baxter This is an exciting time to join Baxter's Internal Audit team as we transform the function and bring it fully in‑house after years of outsourcing. The team is highly supportive, focused on development, and committed to promoting strong performers from within. You'll have clear career growth opportunities and the chance to explore other areas of the company. The role offers diverse project exposure across commercial audits, financial audits, compliance, and strategic initiatives, along with travel opportunities, and dedicated training time for professional development. With strong collaborative culture and flexible work arrangements, this position provides the chance to make an impact while building a long‑term career at Baxter. As an Internal Auditor at Baxter, you will be responsible for using a risk-based approach, assist with audit planning, performing and documenting audit testing procedures for financial and operational audits, SOX testing, management consulting, and other projects, in accordance with the Institute of Internal Auditors Global Internal Audit Standards. Your Team Baxter is a large, global company that provides rich opportunities to develop professionally and learn from one another. Our mission to save and sustain lives is backed by a strong business model and over 90 years of success and growth. As our company's mission comes to life, it brings vast amounts of data with it. The finance organization has the responsibility and privilege of translating this data into meaningful, practical insights to help teams learn and adapt along the way. Our audit team enables leaders and partnering groups to understand the financial implications that their business decisions are projecting to be or are resulting in. We guide these partners to understand financial opportunities or realities that help move Baxter forward and closer to the overall mission. As we work toward our common purpose, we lean on our colleagues for their expertise and collaborate to get work done. As an internal partner to the business, the finance team builds relationships and functions as a thought partner, providing expertise and reliability along the way. This function is friendly and helpful, largely due to the cross-collaborative nature of the roles. While you often work independently with your partner, you always have the greater finance organization to lean on for support or guidance. What you'll be doing Assist in performing a variety of financial, operational and other projects according to the internal audit plan. Conduct testing of transactions and internal controls under the supervision of the senior auditor or manager Evaluate the design and effectiveness of internal controls and identify risks, control gaps, deficiencies, or opportunities for improvement Validate adherence to company policies, procedures, or other relevant requirements Document audit procedures, findings, and evidence in workpapers accurately and completely Draft clear and concise audit findings and help communicate preliminary observations to audit seniors or manager Escalate issues to senior auditors or manager when appropriate Embed a culture of dedication and continuous improvement within the Internal Audit department and auditees Travel domestically and/or internationally up to 25%. What you'll bring Bachelor's degree in accounting, finance, or other relevant field Technical and financial knowledge, including internal control frameworks (e.g., COSO) and accounting principles (e.g., GAAP/IFRS) as well as understanding of relevant business environment. 1+ years of progressive relevant experience, preferably audit experience in the Big 4 or other public accounting firms. Ability to perform data analysis, reconcile information, identify potential risks, and test controls. Working knowledge of Microsoft applications (i.e., Excel, Word, PowerPoint). Accounting or audit certification and foreign language skills are preferred. Familiarity with audit software, ERP systems, or data tools (e.g., Excel, SQL, Power BI) are preferred. Baxter is committed to supporting the needs for flexibility in the workplace. We do so through our flexible workplace policy which includes a required minimum number of days a week onsite. This policy provides the benefits of connecting and collaborating in-person in support of our Mission. The flexible workplace policy is subject to local laws and legal requirements. At its discretion, Baxter may decide to adjust, suspend, or discontinue as business needs change. We understand compensation is an important factor as you consider the next step in your career. At Baxter, we are committed to equitable pay for all employees, and we strive to be more transparent with our pay practices. The estimated base salary for this position is $64,000-$88,000 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than of the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based on upon location, skills and expertise, experience, and other relevant factors. This position may also be eligible for discretionary bonuses. For questions about this, our pay philosophy, and available benefits, please speak to the recruiter if you decide to apply and are selected for an interview. Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. US Benefits at Baxter (except for Puerto Rico) This is where your well-being matters. Baxter offers comprehensive compensation and benefits packages for eligible roles. Our health and well-being benefits include medical and dental coverage that start on day one, as well as insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance. Financial and retirement benefits include the Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount, and the 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching. We also offer Flexible Spending Accounts, educational assistance programs, and time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, and paid parental leave. Additional benefits include commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits. Join us and enjoy the competitive compensation and benefits we offer to our employees. For additional information regarding Baxter US Benefits, please speak with your recruiter or visit our Benefits site: Benefits | Baxter Equal Employment Opportunity Baxter is an equal opportunity employer. Baxter evaluates qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity or expression, protected veteran status, disability/handicap status or any other legally protected characteristic. Know Your Rights: Workplace Discrimination is Illegal Reasonable Accommodations Baxter is committed to working with and providing reasonable accommodations to individuals with disabilities globally. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application or interview process, please click on the link here and let us know the nature of your request along with your contact information. Recruitment Fraud Notice Baxter has discovered incidents of employment scams, where fraudulent parties pose as Baxter employees, recruiters, or other agents, and engage with online job seekers in an attempt to steal personal and/or financial information. To learn how you can protect yourself, review our Recruitment Fraud Notice.

At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America's Best Large Employers and America's Best Employers for Women, Computerworld magazine's list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time's Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999. Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision. Summary Position Highlights The Research Compliance Quality Auditor II leads and conducts complex audits of clinical research studies to ensure adherence to federal and state regulations, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) requirements, institutional policies and procedures, and organizational quality benchmarks. The Research Compliance Quality Auditor II may also be required to: 1. Identify and assess research compliance risks. 2. Investigate special or complex allegations of research/clinical trial noncompliance. 3. Provide expert recommendations for corrective and preventive actions. 4. Develop and deliver compliance education and contribute to policy development. 5. Prepare detailed reports on audit findings and compliance trends for the Research Compliance Officer/Program Manager. The Ideal Candidate: * The ideal candidate will have experience in a research quality and/or auditing environment with expertise, knowledge, and GCP experience in auditing clinical trials, including auditing internal processes, performing sponsor audits and proficiency with electronic systems used to manage clinical trial data or safety reporting. Oncology and/or hematology research experience preferred. * The ideal candidate will have LPN/RN license. Responsibilities: * Prepares, schedules, and conducts audits of investigator-initiated trials (IITs) and pharmaceutical sponsored trials to ensure compliance with applicable federal and state regulations, Good Clinical Practice (GCP) guidelines, and organizational quality standards. * Coordinates and manages corrective and preventive action (CAPA) plans to address audit findings and ensure timely resolution of compliance issues. Oversees audit-related correspondence and documentation, including memos and follow-up communications. * Prepares comprehensive written reports summarizing audit findings and recommendations, and presents results to department administrators, management, and other stakeholders as needed. Evaluates the effectiveness of corrective actions implemented by management to address identified deficiencies. Maintains accurate and organized audit records in accordance with institutional and regulatory requirements. * Develops research compliance training materials and delivers one-on-one and group training sessions to research and compliance staff. Ensures staff understanding and adherence to federal and state regulations, Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) regulations, and other applicable external agency standards, as well as internal research policies and procedures. * Maintains advanced knowledge of federal and state regulations, industry standards, and organizational policies governing clinical research, including Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) requirements, Centers for Medicare & Medicaid Services (CMS) standards, and other applicable agency regulations. Actively engages in professional development through participation in industry trainings, workshops, conferences, and expert discussion forums to ensure compliance expertise remains current and applicable to institutional needs. * Supports other QA projects as needed. Credentials and Experience: * Bachelor's Degree required - Field of study: Health Science, Regulatory Affairs, Research/Health Administration, Public Health, Clinical Research, Biomedical Sciences. * In lieu of a Bachelor's degree, an Associate's degree plus three (3) years of experience in a research quality and/or auditing environment. Experience in leading research auditing or monitoring is preferred. * Licensed Practical Nurse (LPN) or Registered Nurse (RN) required - In lieu of an LPN or RN license, two (2) years of Good Clinical Practice (GCP) auditing experience and a current Certified Clinical Research Professional (CCRP) certification may be considered. * Minimum of four (4) years of experience in a research quality, regulatory, and/or auditing environment, with demonstrated expertise in Good Clinical Practice (GCP) auditing of clinical trials. Experience should include auditing internal processes, performing sponsor audits, and proficiency with electronic systems used for clinical trial data management and safety reporting. * Comprehensive knowledge of International Council for Harmonisation (ICH) Guidelines, Good Clinical Practice (GCP) standards, U.S. Food and Drug Administration (FDA) Code of Federal Regulations, and other applicable laws and regulations governing clinical trials, including pharmaceutical and medical device requirements. * Proven ability to independently audit databases, trial master files, investigator sites, statistical and clinical study reports, and related processes and systems. * Skilled in conducting for-cause audits and computer system validation audits. * Ability to accurately interpret research protocols and audit medical records for compliance. * Advanced verbal and written communication skills for preparing reports and interacting with stakeholders. * Strong organizational, problem-solving, critical thinking, and decision-making abilities. * Ability to work independently or collaboratively on multiple projects with minimal supervision. * Experience in developing and delivering educational programs and workshops on research compliance. * Skilled in investigative methods, data analysis, and negotiation techniques. * Capable of managing and assigning Corrective and Preventive Action (CAPA) plans effectively. * Adaptable in applying investigative approaches for directed and for-cause audits. * Highly detail-oriented, accurate, and pragmatic in problem-solving with strong risk assessment capabilities. 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At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America's Best Large Employers and America's Best Employers for Women, Computerworld magazine's list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time's Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999. Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision. Summary Position Highlights The Research Compliance Quality Auditor I conducts and supports audits of clinical research studies to ensure compliance with regulatory requirements, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice (GCP) guidelines, institutional policies and procedures, and organizational quality standards. The Research Compliance Quality Auditor I may also be required to: 1. Investigate special or complex allegations of research or clinical trial noncompliance. 2. Contribute to faculty and staff education, communication, and policy development. 3. Recommend and monitor corrective actions. 4. Prepare written reports on compliance activities and trends for the Research Compliance Officer/Program Manager. The Ideal Candidate: * The ideal candidate will have experience in a research quality and/or auditing environment with expertise, knowledge, and GCP experience in auditing clinical trials, including auditing internal processes, performing sponsor audits and proficiency with electronic systems used to manage clinical trial data or safety reporting. Oncology and/or hematology research experience preferred. * The ideal candidate will have LPN/RN license. Responsibilities: * Prepares, schedules, and conducts audits of investigator-initiated trials (IITs) and pharmaceutical sponsored trials to ensure compliance with applicable federal and state regulations, Good Clinical Practice (GCP) guidelines, and organizational quality standards. * Coordinates and manages corrective and preventive action (CAPA) plans to address audit findings and ensure timely resolution of compliance issues. Oversees audit-related correspondence and documentation, including memos and follow-up communications. * Prepares comprehensive written reports summarizing audit findings and recommendations, and presents results to department administrators, management, and other stakeholders as needed. Evaluates the effectiveness of corrective actions implemented by management to address identified deficiencies. Maintains accurate and organized audit records in accordance with institutional and regulatory requirements. * Participates in developing research compliance training materials and delivers one-on-one and group training sessions to research and compliance staff. Ensures staff understanding and adherence to federal and state regulations, Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) regulations, and other applicable external agency standards, as well as internal research policies and procedures. * Maintains advanced knowledge of federal and state regulations, industry standards, and organizational policies governing clinical research, including Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) requirements, Centers for Medicare & Medicaid Services (CMS) standards, and other applicable agency regulations. Actively engages in professional development through participation in industry trainings, workshops, conferences, and expert discussion forums to ensure compliance expertise remains current and applicable to institutional needs. * Provides support for additional research compliance and quality assurance projects as assigned. Credentials and Experience: * Bachelor's Degree required - Field of study: Health Science, Regulatory Affairs, Research/Health Administration, Public Health, Clinical Research, Biomedical Sciences. * In lieu of a Bachelor's degree, an Associate's degree plus two (2) years of experience in a research quality and/or auditing environment. Experience in leading research auditing or monitoring is preferred. * Licensed Practical Nurse (LPN) or Registered Nurse (RN) required - In lieu of an LPN or RN license, two (2) years of Good Clinical Practice (GCP) auditing experience and a current Certified Clinical Research Professional (CCRP) certification may be considered. * Minimum of three (3) years of experience in a research quality and/or regulatory environment, Including clinical trial conduct, protocol adherence, regulatory submissions, and proficiency with electronic systems for clinical trial data or safety reporting. * Comprehensive knowledge of International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Guidelines, Good Clinical Practice (GCP), Food and Drug Administration's Code of Federal Regulations, and other applicable laws and regulations governing clinical trials, including pharmaceutical and medical device. * Proven ability to independently review databases, trial master files, investigator sites, statistical/clinical study reports, and related processes/systems; experience conducting computer system validation audits/reviews. * Skilled in interpreting research protocols and validating source documentation within medical records. * Advanced verbal and written communication skills. * Strong organizational, problem-solving, critical thinking, and decision-making abilities. * Ability to work independently or collaboratively on multiple projects with minimal supervision. * Experience developing and delivering educational programs and workshops. * Proficient in investigative methods and negotiation techniques for audits and compliance reviews. * Highly detail-oriented, accurate, and pragmatic in problem-solving with strong risk assessment capabilities. 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At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America's Best Large Employers and America's Best Employers for Women, Computerworld magazine's list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time's Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999. Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision. Summary Position Highlights: * Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, and federal and state regulations and guidelines. * The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff and provides physician and coder education. * The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs and will serve as an institutional subject matter expert and authoritative resource. The Ideal Candidate Will Have The: * Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties. * Ability to work in both independent contributor and team roles (both as a team leader and team member) * Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership. Responsibilities: * Plans and performs scheduled and unscheduled professional or hospital compliance department audits, including accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews. * Evaluates the appropriateness of services and procedures billed based on supporting documentation. * Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. * Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices. * Develops compliance training content and provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others. * Conducts compliance orientation training for new providers. * Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations. Serves as institutional subject matter expert and authoritative resource in these areas. Credentials and Qualifications: * Bachelor's degree in Health Information Management, Business or related field. * Three (3) years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work. * In lieu of a bachelor's degree, HS Diploma/GED and seven (7) years of relevant experience will be considered. * Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.). * Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing. * Knowledge of Medicare and Medicaid documentation and coding rules and guidelines. * Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation. Preferred: * Professional and/or hospital services auditing experience in an Academic Medical Center. * Prior experience working in a Corporate Compliance environment. * Prior experience working in a Cancer Hospital. * Prior experience working in a Revenue Cycle Operations role. * Knowledge of Soarian and/or Soarian PRM applications. * Knowledge of Cerner Powerchart applications. Share:

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion. Primary Purpose Conducts routine audits of specific operations requiring the development of data, interpretation of intangible or unusual factors, summarization of findings and presentation of recommendations and suggestions. Minimum Specifications Education Must have a Bachelor's degree in Business or Healthcare related field. Must have a minimum of fifteen hours of college level courses which include subjects of accounting, statistics, data analysis/extraction and/or healthcare administration. Experience Must have two years of previous operational & financial audit experience in a healthcare environment; OR, Must have two years of progressively responsible experience doing operational and financial audits in an internal audit environment; OR Must have two years of progressively responsible experience in a healthcare environment. Equivalent Education and/or Experience May have a Master's Degree in lieu of two years of experience. Certification/Registration/Licensure Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), or Certified Public Accountant (CPA) preferred. Skills or Special Abilities Must have effective oral and written communication skills. Must be a good listener, be flexible, be able to balance multiple projects, and possess good business and negotiation skills. Must be able to demonstrate the ability to write a finding in a clear and concise audit report. Must have strong analytical and statistical skills and be able to perform analyses to obtain supported results using organizational data. Must be proficient with MS Office (Word, Excel, VISIO, PowerPoint) software applications and have an aptitude to learn the organization's accounting, payroll, and electronic medical record systems. Must have strong organizational skills and be able to demonstrate both analytical and statistical skills. Must demonstrate effective problem-solving skills. Must have the ability to understand audit standards and governmental regulations. Must be a self-starter with the ability to work effectively as part of a team, and on an independent basis. Responsibilities Assists in determining the direction and approach of assigned audits and assists with writing the audit program subsequent to gaining and understanding and performing the risk assessment and based upon the scope established for the audit. Conducts limited scope, less complex, or portions of larger scope audits. Assists in determining the materiality of the issues reviewed and reported; ensuring that assets are safeguarded, internal controls are present, resources are used efficiently, and that all activity and costs are appropriate. Using an automated system, prepares work papers and documents each step, validates all information through whatever sources are available. Using the workpaper application, enters project related milestones, maintains project related data, and maintains an accounting of project time. Participates in meetings with the audited function periodically throughout the audit to discuss audit plans, audit findings, and to assist in developing mutually agreed-upon recommendations Maintains a positive working relationship with all hospital functions to ensure the fulfillment of auditing responsibilities. Prepares a clear, concise audit report detailing the findings and recommendations. Perform follow-up audits of areas previously audited to ascertain that recommendations and time schedules are being followed from the initial audit. Assists with special projects and/or serves on various interdisciplinary committees as assigned. May assist in conducting special studies of specific operations and may provide support to the annual financial audit of Parkland. Communicates clearly and effectively with audit clients, internal audit team and others. Demonstrates effective communication by clearly and succinctly providing detailed audit information and by providing direct and clear responses to address questions. Maintains knowledge, competencies, and application of rules, regulations, policies, laws, and guidelines that impact the area. Demonstrate effective and continuous learning. Demonstrate high degree of self-motivation and initiative. Demonstrate critical thinking and problem solving. Demonstrate openness and flexibility to various work assignments. Maintain collaborative and positive work relationships. Exhibit strong project management skills adhering to budgets and deadlines. Job Accountabilities Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding. Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.

Job DescriptionSalary: At Hamilton Enterprises, our people are our greatest differentiator and competitive advantage in the markets we serve.Hamilton Enterprises(************** prides itself on our integrity, a dedication to providing high quality work products and services, and an excellent work environment, and we maintain a commitment to provide employees with fulfilling careers while maintaining a healthy life-work balance. As a member of our audit team you will be conducting financial audits, performance audits and reviews. You will also be performing agreed-upon procedures, internal control reviews, and consulting engagements. We offer a casual office environment and an attractive compensation package including paid time off, flexible schedules, federal holidays, health and dental insurance, continued professional education and a 401K matching program. Due to our continued success and growth, we are currently looking for staff auditors to join our team. Qualifications No auditing experience required. Open to recent college graduates. Bachelors or Masters degree in Accounting or related field. CPA or actively preparing to pass the CPA exam in near future. Goodcomputersskills and proficient with the MS Office suite of software products. Excellent verbal and written communication skills. The ability to work well in both team and independent settings. Good analytical, time management and research skills. H1-B Sponsorship or Transfer -- Yes. Hamilton Enterprises is an Equal Opportunity Employer and considers all qualified applicants without regard to color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability and any other classification protected by law.

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 Assistant to the AVP of Risk Management and Compliance. Will be conducting independent and objective audits/reviews of departments and procedures to determine compliance with Federal and State regulations, specifically as it relates to Federal Healthcare Programs. POSITION REQUIREMENTS / QUALIFICATIONS: Education/Experience: Bachelor's Degree in Accounting, Finance or Business Administration. Three (3) years' experience in a Health Care Organization, preferably in a community health center. Licensure / Certification: Maintain current CPR certification from the American Heart Association. Skills / Ability: Fluency in English/Spanish. Demonstrates proficiency in communication and written skills. Position requires audit skills, preparation of reports to management and knowledge of Federal and State regulations which affect Healthcare. POSITION RESPONSIBILITIES (THIS IS AN EXEMPT POSITION) The incumbent serves at the pleasure of the President/CEO. Administrative duties in support of the Compliance Officer, whose duties are complex and broad in scope, in ensuring Community Health of South Florida, Inc. is in compliance with policies, procedures and regulation. Ability to use resources effectively and in recommending implementation of the types of internal controls that are preventive, detective and corrective in nature. Preparing worksheets to be utilized for audit/reviews as instructed by the Compliance Officer. Securing supporting documentation that substantiates audit/review findings. Researches regulations by reviewing regulatory bulletins and other sources of information. Monitors the Employee Reporting Hotline Preparing monthly reports and collecting necessary data. Conducts and participates in in-service training. Prepares reports by collecting, analyzing, and summarizing information. Works with the Compliance Officer to audit areas identified during risk assessments, items pertinent to the medical practice as identified by annual OIG work-plans, and other compliance and risk areas identified by the Compliance Officer. Performs on-going compliance audits utilizing as necessary, evaluation tools relating to audit; monitoring activities. Under the direction of the Compliance Officer identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified. Under the direction of the Compliance Officer, performs risk assessments and determine the level of risk by: *Understanding laws and regulations *Obtaining and/or establishing policies for specific issues and areas *Educate on the policies and procedures and communicate awareness *Monitor compliance with laws, regulations, and policies *Audit the highest risk areas *Re-educate staff on regulations and issues identified in the audit Participate in Quality Assurance and Quality Improvement Programs and activities Performs other duties as assigned.

Join Our Mission to Save and Enhance Lives Are you looking for a meaningful career where your skills and experience can make a life-saving difference? Do you want to contribute to a mission that leaves an incredible legacy? If so, Indiana Donor Network invites you to explore joining our team. Why Indiana Donor Network? Indiana Donor Network is a nationally recognized healthcare organization, serving as the crucial link between donors and patients awaiting life-saving organ transplants, healing tissue, and corneas that restore sight. As the state's federally designated organ recovery organization and an accredited tissue bank, we are dedicated to making a profound impact on countless lives. We are currently seeking an Internal Compliance Auditor to help fulfill our mission. About the Role The Internal Compliance Auditor is responsible for creating and maintaining all aspects of the internal audit function, vendor qualifications, and validations by identifying risks associated with various state, federal, and industry regulatory agencies in an effort to improve and sustain the organization's ability to further organ and tissue donation and transplantation. Provides advice and facilitation on the development of technical aspects of quality improvement efforts. Additional key responsibilities include: Performs scheduled, unannounced, and follow-up internal and external audits as scheduled and as necessary to evaluate the organization's performance as compared to internal and regulatory requirements. Communicates the purpose, necessity, and results of all internal audit programs to the appropriate stakeholders of the organization. Maintains vendor qualification program and performs surveys as scheduled and as necessary to evaluate an appropriate level of confidence that suppliers, vendors, and contractors are able to supply consistent quality of materials, components, and services in compliance with regulatory requirements. Documents internal audit and vendor qualification activities to contribute to the organization's quality program and to effectively evaluate performance of clinical and non-clinical operations. Oversees validation program to contribute to the organization's quality program and to effectively evaluate performance of equipment, supplies, and controlled documents. Actively participates as a liaison with the Indiana Donor Network leadership team. Completes special projects and/or assignments as directed in the areas of clinical data, quality systems, and/or clinical operations to support departmental quality improvement initiatives. Who We're Looking For A bachelor's degree in applied science or related field is required. A master's degree in business management is preferred. A minimum of five years' experience in auditing, including Lean Healthcare/Six Sigma training, and ASQ certification or equivalent is required. Medical experience or organ and/or tissue procurement/certification experience is preferred. Additional desired knowledge, skills and abilities include: Requires incumbent to be successful in working with all levels of Indiana Donor Network personnel. Basic knowledge of medical terminology and medications that relate to organ/tissue donation. Demonstrate proficiency in Microsoft Office, online databases and data entry, query, and reporting. Demonstrate organizational skills with ability to manage multiple tasks and set priorities. Demonstrate independent decision-making skills and ability to work autonomously. Skill in identifying and recommending improvements in policies, processes, and procedures. Skill in determining alternatives that would correct a situation to provide effective service to donor partners. Skill in maintaining composure and de-escalating emotionally charged situations. Skill in preparing written materials such as correspondence and reports to meet purpose and audience. Skill of receiving a message, understanding the intended message, and giving feedback to ensure expectations are met. Ability to establish and maintain positive and productive working relationships with vendors, coroners, funeral homes, regulatory agencies, etc. Ability to work cooperatively within a group to make the work of the group successful and effective. Ability to maintain open, clear, timely, and expected channels of communication, present ideas clearly and persuasively, and respond well to questions. Ability to maintain confidentiality of donor related records. Benefits & Perks At Indiana Donor Network, we believe in taking care of our team members. We offer: 100% employer paid health, dental, and vision insurance for our employees and dependents Annual health savings account contributions Paid pet insurance Annual bonuses for performance and retention Generous paid time off and holiday pay Professional development and growth opportunities A mission-driven, supportive work culture Join Our Life-Saving Mission If you are looking for a rewarding career where your work directly impacts lives, apply today and become part of our compassionate and dedicated team at Indiana Donor Network. Indiana Donor Network is an equal opportunity employer. Employment is contingent upon successfully passing drug screening and background check, including verification with the Social Security Administration, criminal records review, DMV check, and the Office of Inspector General.

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 USD $84,200.00/Yr. Max USD $95,000.00/Yr.

Current Saint Francis Employees - Please click HERE to login and apply. Full Time Days Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis Health System (SFHS). This role supports clinical coding and billing audit functions as well as the performance of routine and complex audits, oversight activities, and coordinates remediation and corrective action plans. Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 3 years of healthcare compliance clinical auditing experience within a hospital setting. Deep understanding of medical necessity, documentation standards, and clinical validation. Highly detail-oriented with strong critical-thinking and analytical skills. Ability to apply audit methodology consistently and defensibly. Comfortable reviewing large volumes of medical records and data. Collaborative approach with Compliance, Revenue Cycle, Case Management, Legal, and Operations Knowledge, Skills and Abilities: Strong knowledge of Centers for Medicare and Medicaid Services (CMS) guidance, regulations, policies, and direction from other government programs. Advanced proficiency within Microsoft 365. Ability to learn departmental and job-specific software programs. Excellent communication skills, both written and verbal that present clear and concise information. Superior ability to collect, analyze, and disseminate significant amounts of data with attention to detail and accuracy. Strong project management skills with the ability to manage multiple priorities simultaneously. Essential Functions and Responsibilities: Provides compliance program support with audits and monitoring, corrective action plan management, data analytics, and other projects to ensure proper execution of the compliance program work plan and priorities. Performs audits to ensure that the clinical documentation contained within the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment, and operations. Performs clinical review audits to validate compliance with regulatory requirements such as Emergency Medical Treatment Labor Act (EMTALA), Discharge Planning, and Quality. Provides independent evaluations and assists with the maintenance of operational controls, tools, policies, and procedures. Conducts regulatory research to identify gaps and provides interpretation of clinical requirements and regulations to ensure appropriate application of medical and clinical criteria. Remains abreast of current developments in compliance. Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field Working Relationships: Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above. Special Job Dimensions: None. Supplemental Information: This document generally describes the essential functions of the job, and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties. Corporate Compliance - Yale Campus Location: Tulsa, Oklahoma 74136 EOE Protected Veterans/Disability

**Current Saint Francis Employees - Please click HERE (*************************************************************** **to login and apply.** Full Time Days Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis Health System (SFHS). This role supports clinical coding and billing audit functions as well as the performance of routine and complex audits, oversight activities, and coordinates remediation and corrective action plans. Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 3 years of healthcare compliance clinical auditing experience within a hospital setting. Deep understanding of medical necessity, documentation standards, and clinical validation. Highly detail-oriented with strong critical-thinking and analytical skills. Ability to apply audit methodology consistently and defensibly. Comfortable reviewing large volumes of medical records and data. Collaborative approach with Compliance, Revenue Cycle, Case Management, Legal, and Operations Knowledge, Skills and Abilities: Strong knowledge of Centers for Medicare and Medicaid Services (CMS) guidance, regulations, policies, and direction from other government programs. Advanced proficiency within Microsoft 365. Ability to learn departmental and job-specific software programs. Excellent communication skills, both written and verbal that present clear and concise information. Superior ability to collect, analyze, and disseminate significant amounts of data with attention to detail and accuracy. Strong project management skills with the ability to manage multiple priorities simultaneously. Essential Functions and Responsibilities: Provides compliance program support with audits and monitoring, corrective action plan management, data analytics, and other projects to ensure proper execution of the compliance program work plan and priorities. Performs audits to ensure that the clinical documentation contained within the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment, and operations. Performs clinical review audits to validate compliance with regulatory requirements such as Emergency Medical Treatment Labor Act (EMTALA), Discharge Planning, and Quality. Provides independent evaluations and assists with the maintenance of operational controls, tools, policies, and procedures. Conducts regulatory research to identify gaps and provides interpretation of clinical requirements and regulations to ensure appropriate application of medical and clinical criteria. Remains abreast of current developments in compliance. Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field Working Relationships: Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above. Special Job Dimensions: None. Supplemental Information: This document generally describes the essential functions of the job, and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties. Corporate Compliance - Yale Campus Location: Tulsa, Oklahoma 74136 **EOE Protected Veterans/Disability**