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Auditor jobs at Metropolis

- 71 jobs
  • Coding Auditor Educator, Inpatient

    Highmark Inc. 4.5company rating

    Pennsylvania jobs

    * This role will cover Inpatient Auditors and will require Inpatient (AHIMA) credentials. Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching plans in accordance with federal and state regulations and guidelines ESSENTIAL RESPONSIBILITIES: * Plans and \conducts audits and reports on the documentation, coding and billing performed at AHN entities. Reviews, develops and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external audit findings and responds as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare appeal letter follow up and identify education issues. (20%) * Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial impact and profitability. Conducts education/training or works with external resources to present final audit findings to department staff, physicians and appropriate individuals. (20%) * Validates the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster. (10%) * Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify patterns, trends and variations in the facilities frequently assigned DRG/APC groups. Once identified, evaluate the cases of the change or problems and takes appropriate steps to effect resolution. (10%) * Reviews and interprets medical information, classifies that information into the appropriate payor specific groups consisting of ICD-CM ICD-PCS and CPT codes for diagnoses and procedures and calculates the DRG and APC. (10%) * Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines. Assures compliance with the coding guidelines and regulatory requirements. (10%) * Performs other duties as assigned or required including training/mentoring of new staff, performing audits and research related to special projects and providing coverage for coding manager(s). (10%) * Depending on location provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management, designs and implements coder education program, continuing education programs and Medical Staff education programs. Establishes and monitors performance and maintains appropriate documentation thereof. (10%) * Other duties as assigned. QUALIFICATIONS: Minimum * High school diploma / GED * Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) * AHIMA Credentials (Inpatient or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) * AAPC Credentials (Outpatient): Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) * 5 years with hospital or physician coding and/or auditing, as well as, education techniques and methods. (Internal transfer and promotion candidates may have a minimum of 3 years experience) * In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems. Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS Official Guidelines, Outpatient Prospective payment system and Coding Clinic references. Current working knowledge of encoder, grouper, abstracting and other related software. * Strong analytical and communication skills Preferred * Associate's Degree * 3 years with claims processing and data management * Past auditing and strong education/training background in coding and reimbursement Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $27.36 Pay Range Maximum: $42.41 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice
    $27.4-42.4 hourly Auto-Apply 55d ago
  • Content Auditor

    Scaleai 4.1company rating

    San Francisco, CA jobs

    About the job - Employment Type: Remote (Part-Time) - Compensation: Up to USD 18 per hour, depending on location, experience, scope of responsibilities, and performance. About the Role - This role focuses on auditing content for accuracy, consistency, compliance, and quality standards across digital materials and submissions in a fully remote environment. - You will collaborate closely with the team to identify issues, verify guidelines, document findings, and help keep audit processes organized, content compliant, and quality workflows efficient. Key Responsibilities - Assist with content audit-focused project tasks such as content verification, compliance checks, accuracy assessment, issue documentation, data entry and maintenance, online research, basic analysis, operations support, AI-output review, documentation, and coordination. - Review, organise, and update audit files and related information with a high level of accuracy and attention to detail. - Communicate clearly with team members through written and verbal channels and provide timely updates on task status and progress. Skills & Qualifications - Strong command of written English and clear, professional communication skills. - Comfort using digital tools such as email, spreadsheets, audit platforms, project management or online productivity tools. - Analytical mindset with strong attention to detail and accuracy. - Ability to manage time, prioritise tasks, and work independently in a remote environment. - Interest in content auditing, compliance verification, quality control, or data-related work is helpful but not required; training and onboarding will be provided. What We Offer - 100% remote work, with flexible scheduling aligned to team needs and agreed time zones. - Weekly payments via secure, compliant payment methods, with a clear and transparent compensation structure. - Opportunities to build skills in research, content operations, data handling, content auditing, and AI-related workflows. - A supportive work culture that encourages feedback, learning, and long-term professional growth. - You must be legally authorised to work in the country where you are based. We welcome applicants from all backgrounds and make hiring decisions based solely on qualifications, experience, and business needs, in line with applicable employment and anti-discrimination laws. Apply now to be considered for this opportunity.
    $34k-56k yearly est. 7d ago
  • Healthcare Compliance Auditor (Healthcare Transaction & Strategy)

    Berkeley Research Group 4.8company rating

    Washington, DC jobs

    We do Consulting Differently The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at either the Consultant or Managing Consultant level. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include working with team to develop audit specifications, expert analysis of healthcare claims and supporting documentation, quality control, and development of client deliverables. The work of a Consultant involves execution of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: billing and coding audits, compliance program review, quality control, development of client deliverables, and industry research. The work of a Managing Consultant involves both execution and oversight of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: management of junior staff, quality control, development and presentation of client deliverables, and industry research. This specific position will require knowledge of medical coding and compliance and potential candidates must have medical auditing expertise. Job title and compensation to be determined based on qualifications and experience. Job Responsibilities: Plan and perform medical record audits to determine coding accuracy and compliant claims submission; Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance; Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines; Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement; Serve as a subject matter expert on interpretation and application of coding and documentation guidelines; Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas; Stay current on coding guidelines. Develop analyses using transactional data and/or financial data; Generate client deliverables and make valuable contributions to expert reports; Manage client relationships and communicate results and work product as appropriate; Manage junior staff and delegate assignments as directed by more senior managers; Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions; Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting; Prioritize assignments and responsibilities to meet goals and deadlines. Qualifications: An undergraduate degree (e.g., BS, BA); Active coding certification from either AAPC or AHIMA is required; Preference will be given to candidates that are certified in medical auditing; 2+ years of work experience with a focus on healthcare provider billing and coding; 5-7 years of experience is required for the Managing Consultant level position. Job title to be determined based on relevant qualifications and experience. Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs). Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation. Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements. Required skills include: Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results. Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word. A desire to expand those capabilities is required, as is the ability to train others to use such tools. Commitment to producing high quality analysis and attention to detail. Excellent time management, organizational skills, and ability to prioritize work and meet deadlines. Keen interest in healthcare compliance and healthcare policy. Exceptional verbal and written communication skills. Desire to work within a team environment. Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship. Consultant Salary Range: $70,000 - $150,000 Managing Consultant Salary Range: $100,000 - $230,000 #ThinkBRG #LI-JQ1|#LI-REMOTE About BRG BRG combines world-leading academic credentials with world-tested business expertise purpose-built for agility and connectivity, which sets us apart-and gets you ahead. At BRG, our top-tier professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of proven real-world experience to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges for organizations across the globe. Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking from diverse perspectives that, when paired with our global reach and resources, make us uniquely capable to address our clients' challenges. We get results because we know how to apply our thinking to your world. At BRG, we don't just show you what's possible. We're built to help you make it happen. BRG is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.
    $100k-230k yearly Auto-Apply 48d ago
  • Coding Auditor Educator, Inpatient

    Highmark Health 4.5company rating

    Harrisburg, PA jobs

    **_*This role will cover Inpatient Auditors and will require Inpatient (AHIMA) credentials._** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching plans in accordance with federal and state regulations and guidelines **ESSENTIAL RESPONSIBILITIES:** + Plans and \conducts audits and reports on the documentation, coding and billing performed at AHN entities. Reviews, develops and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external audit findings and responds as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare appeal letter follow up and identify education issues. (20%) + Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial impact and profitability. Conducts education/training or works with external resources to present final audit findings to department staff, physicians and appropriate individuals. (20%) + Validates the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster. (10%) + Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify patterns, trends and variations in the facilities frequently assigned DRG/APC groups. Once identified, evaluate the cases of the change or problems and takes appropriate steps to effect resolution. (10%) + Reviews and interprets medical information, classifies that information into the appropriate payor specific groups consisting of ICD-CM ICD-PCS and CPT codes for diagnoses and procedures and calculates the DRG and APC. (10%) + Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines. Assures compliance with the coding guidelines and regulatory requirements. (10%) + Performs other duties as assigned or required including training/mentoring of new staff, performing audits and research related to special projects and providing coverage for coding manager(s). (10%) + Depending on location provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management, designs and implements coder education program, continuing education programs and Medical Staff education programs. Establishes and monitors performance and maintains appropriate documentation thereof. (10%) + Other duties as assigned. **QUALIFICATIONS:** Minimum + High school diploma / GED + Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) + AHIMA Credentials (Inpatient or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician coding and/or auditing, as well as, education techniques and methods. (Internal transfer and promotion candidates may have a minimum of 3 years experience) + In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems. Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS Official Guidelines, Outpatient Prospective payment system and Coding Clinic references. Current working knowledge of encoder, grouper, abstracting and other related software. + Strong analytical and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background in coding and reimbursement **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $27.36 **Pay Range Maximum:** $42.41 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J256583
    $27.4-42.4 hourly 60d+ ago
  • Quality, Regulatory & Audit Specialist, Senior

    Infor 4.8company rating

    Dallas, TX jobs

    General information Country United States State Georgia City Dallas Job ID 46177 Department Finance And Administration Experience Level ASSOCIATE Employment Status FULL_TIME Workplace Type Hybrid Description & Requirements Infor is looking for a Quality, Regulatory and Audit Specialist who will be responsible for performing a wide variety of compliance activities for Infor teams that develop, sell and support software products. The Quality, Regulatory & Audit team owns the Infor QMS (Quality Management System) and collaborates with all Infor departments. Our goal is to develop SOPs that meet our customers' needs as well as our own regulatory requirements. Most compliance topics are related to ISO 27001, ISO 9001, FDA 21 CFR Part 11, ISO 42001 and NIS2, but will also support customers with requirements for TISAX, CMMC, HIPAA, PCI, SOX and other regulations as needed. A Day In the Life Typically Looks Like: * Work with teams to create and improve policies, procedures and templates following a strict document control system. * Perform internal audits of software development teams and other departments (such as IT, SaaS, HR and customer support) against ISO 9001, against our SSDLC policy and ISO 27001. Manage audit projects, documentation, stakeholder communication, follow-ups. * Building relationships with internal customers (Sales, Security, Development) to anticipate needs and understand risks . * Support 2nd party (customer) audits of Infor by completing due diligence questionnaires and hosting virtual or on-site audits. * Participate in 3rd party audits of Infor. These could relate to ISO 27001, ISO 42001, TISAX, HIPAA, PCI and SSAE 18. * Participate, and contribute, in corporate risk assessments primarily for ISO 27001 and conduct gap analysis for compliance with new regulations against the ISO 27001 framework. Basic Qualifications: * Control framework knowledge and documentation skills. * A background in SaaS, software development, or IT systems. * Prior experience with both internal and external audits. * Prior experience conducting corporate risk assessments. * Legal authorization to work permanently in the United States for any employer without requiring a visa transfer or visa sponsorship now or in the future. Preferred Qualifications: * Experience working in a regulated environment and/or with regulated customers. * Project management skills. * Bachelor of Science in Engineering, Computer Science or Associate degree. * ISO 9001/13485/27001 auditor training. * Knowledge of one or more of the following: GAMP 5, FDA 21 CFR Part 11/ EU Annex 11, Software Validation, ISO 9001, ISO 13485, ISO 27001, ISO 42001, CMMC, HIPAA. * Experience in customer interactions, sales support and/or coaching. About Infor Infor is where ambition meets impact. Join a global community of bold thinkers and innovators, where your expertise doesn't just solve problems. it shapes industries, unlocks opportunities, and creates real-world impact for billions of people. At Infor, you're not just building a career. you're helping to build what's next. Infor is a global leader in business cloud software products for companies in industry specific markets. Infor builds complete industry suites in the cloud and efficiently deploys technology that puts the user experience first, leverages data science, and integrates easily into existing systems. Over 60,000 organizations worldwide rely on Infor to help overcome market disruptions and achieve business-wide digital transformation. For more information visit ************* Our Values At Infor, we strive for an environment that is founded on a business philosophy called Principle Based Management (PBM) and eight Guiding Principles: integrity, stewardship & compliance, transformation, principled entrepreneurship, knowledge, humility, respect, self-actualization. We have a relentless commitment to a culture based on PBM. Informed by the principles that allow a free and open society to flourish, PBM prepares individuals to innovate, improve, and transform while fostering a healthy, growing organization that creates long-term value for its clients and supporters and fulfillment for its employees. Infor is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive work environment. Infor does not discriminate against candidates or employees because of their sex, race, gender identity, disability, age, sexual orientation, religion, national origin, veteran status, or any other protected status under the law. If you require accommodation or assistance at any time during the application or selection processes, please submit a request by following the directions located in the FAQ section. Fraud Awareness We have been made aware of unauthorized individuals posing as Infor recruiters, including some who have made fraudulent offers of employment. Please read our guidelines and protect yourself from recruitment scams. Fraud Privacy Policy We value your privacy at Infor. You may access our privacy policy here. This employer uses E-Verify. Please visit this website for additional information. E-Verify Illinois: Click here, aquí, or tu.
    $72k-95k yearly est. 19d ago
  • Fedramp-Quality, Regulatory & Audit Specialist

    Infor 4.8company rating

    Dallas, TX jobs

    General information Country United States State Texas City Dallas Job ID 46327 Department Finance And Administration Experience Level MID_SENIOR_LEVEL Employment Status FULL_TIME Workplace Type Hybrid Description & Requirements We are seeking a highly organized and detail-oriented Compliance Operations Professional to oversee and manage activities, communications, and deliverables for Infor's FedRAMP service. This role is critical to ensuring our compliance with federal government regulations, involving documentation, data mining, and reporting processes. The ideal candidate will work closely with cross-functional teams to track and report on compliance status, ensuring that all deliverables meet the strict timeframes set by the federal government, and keep the various stakeholders informed. A Day in The Life Typically Includes: * Organize, Track, and ensure Delivery of Monthly Deliverables for multiple regulatory bodies. * Integrate and operate with Security in Continuous Monitoring functions. * Manage Plan of Action and Milestones to completion with Stakeholder updates from SVP to Engineering levels. Required skills: * Experience in project management, with a demonstrated ability to manage timelines and deliverables in high-pressure environments. * Experience mining and interpreting data for decision-making and reporting purposes. * Legal authorization to work permanently in the United States for any employer without requiring a visa transfer or visa sponsorship now or in the future. Preferred skills: * Experience working in a SaaS company, technology company, or other related industry. * Exposure to federal compliance frameworks, including FedRAMP, NIST, or other related standards. * Familiarity with vulnerability management processes and tools specific to federal compliance requirements. * Ability to navigate the intricacies of working with government agencies and an understanding of the reporting and documentation required in the federal space. About Infor Infor is where ambition meets impact. Join a global community of bold thinkers and innovators, where your expertise doesn't just solve problems. it shapes industries, unlocks opportunities, and creates real-world impact for billions of people. At Infor, you're not just building a career. you're helping to build what's next. Infor is a global leader in business cloud software products for companies in industry specific markets. Infor builds complete industry suites in the cloud and efficiently deploys technology that puts the user experience first, leverages data science, and integrates easily into existing systems. Over 60,000 organizations worldwide rely on Infor to help overcome market disruptions and achieve business-wide digital transformation. For more information visit ************* Our Values At Infor, we strive for an environment that is founded on a business philosophy called Principle Based Management (PBM) and eight Guiding Principles: integrity, stewardship & compliance, transformation, principled entrepreneurship, knowledge, humility, respect, self-actualization. We have a relentless commitment to a culture based on PBM. Informed by the principles that allow a free and open society to flourish, PBM prepares individuals to innovate, improve, and transform while fostering a healthy, growing organization that creates long-term value for its clients and supporters and fulfillment for its employees. Infor is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive work environment. Infor does not discriminate against candidates or employees because of their sex, race, gender identity, disability, age, sexual orientation, religion, national origin, veteran status, or any other protected status under the law. If you require accommodation or assistance at any time during the application or selection processes, please submit a request by following the directions located in the FAQ section. Fraud Awareness We have been made aware of unauthorized individuals posing as Infor recruiters, including some who have made fraudulent offers of employment. Please read our guidelines and protect yourself from recruitment scams. Fraud Privacy Policy We value your privacy at Infor. You may access our privacy policy here. This employer uses E-Verify. Please visit this website for additional information. E-Verify Illinois: Click here, aquí, or tu.
    $72k-95k yearly est. 25d ago
  • Outpatient Coding Auditor

    E4Health 3.8company rating

    Pittsburgh, PA jobs

    Job DescriptionDescription: At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do: Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth. Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day. WE GROW: We believe in win/win outcomes-when our customers win, we win. GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions. Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at ************** POSITION TITLE: Outpatient Auditor ROLE TYPE: Full Time / Part Time EMPLOYMENT TYPE: Non-Exempt JOB SUMMARY: The Outpatient Auditor is responsible for completing quality assurance reviews on internal and/or external outpatient coding specialists or external providers. The facility-based chart types may include one or more of the following: Emergency Department, Observation, Same Day Surgery, Ancillary, Interventional Radiology, or Facility-Based Clinic. This may also include onboarding audits and training of newly hired e4health coding specialists. This role is responsible for validating the coding specialist is accurately for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, and CMS directives. The Outpatient Auditor also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding specialist, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Outpatient Auditor is expected to maintain consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards. ESSENTIAL DUTIES AND RESPONSIBILITIES: Complete all regularly scheduled quality assurance reviews for clients Complete onboarding quality assurance reviews for newly hired consultants May provide training for newly hired coding consultants Communicate quality issues to management as appropriate Assist with identification of, drafting, implementation, and monitoring of quality improvement action plans for coding consultants Maintain reports and accuracy rates for coding consultants and clients as appropriate. Respond to client QA needs at the direction of management Provide coding consultants educational sessions on error trends as requested by management Notifying management when there is a compliance concern or incident Demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information Promoting confidentiality and using discretion when handling patient information. Attend educational conference calls Provide coding support to the business as needed Perform other duties as needed with the project Maintains required productivity and quality requirements Maintains coding credential requirements BENEFITS: We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy. PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS: This role requires prolonged periods of desk working on a computer Talking, hearing, and near vision are required to perform computer-based tasks and virtual communication Sensory perception (visual, auditory, and tactile) is essential for computer and phone use WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS: This is a remote role; work is performed in a home office environment. e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category. Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position . Requirements: REQUIRED QUALIFICATIONS: Candidate must possess an approved AHIMA or AAPC coding credential; CIRCC/RCCIR a plus Minimum 4 years' coding experience required; specialty experience may be preferred as per specific client needs Minimum 2 years of auditing experience preferred Recommend at least 2 years of remote experience KEY SUCCESS ATTRIBUTES: Integrity, passion, and ethics are required Demonstrates strong collaboration skills Has strong analytic and problem-solving abilities and techniques Exhibit consistent initiative with strong drive for results and success Demonstrate commitment to a team environment? Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail Ability to self-motivate and self-direct Possess strong time management and organizational skills Commitment and adherence to company Core Values CORE COMPETENCIES: High level of integrity & ethical judgement Communication Consistency and Reliability Meeting Standards
    $31k-53k yearly est. 19d ago
  • Inpatient Auditor - Client Facing Opportunity!

    E4Health 3.8company rating

    Pittsburgh, PA jobs

    Job DescriptionDescription: At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do: Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth. Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day. WE GROW: We believe in win/win outcomes-when our customers win, we win. GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions. Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at ************** POSITION TITLE: Inpatient Auditor ROLE TYPE: Full Time (x2 openings) EMPLOYMENT TYPE: Non-Exempt JOB SUMMARY: The Inpatient Auditor is responsible for completing quality assurance reviews on internal and external inpatient coders. This includes onboarding audits and training of newly hired e4health inpatient coders. The role validates that coders accurately abstract data into client electronic medical record systems, following Official ICD-10-CM and ICD-10-PCS Guidelines, UHDDS guidelines, and CMS directives. The auditor also validates Present on Admission (POA) indicators per AHA POA guidelines and identifies missing or inappropriate provider queries. The Inpatient Auditor plays a key role in reporting quality results, tracking educational opportunities, responding to client needs, and providing educational support and training. ESSENTIAL DUTIES AND RESPONSIBILITIES: Complete scheduled quality assurance reviews for both internal teams and external client organizations Conduct onboarding audits and training for newly hired inpatient coders Deliver training sessions and educational feedback to coders, including those at client sites Communicate quality issues and audit findings to management and client contacts. Assist in drafting, implementing, and monitoring quality improvement action plans for coders Maintain reports and accuracy rates for coders and clients Respond to client QA needs and inquiries as directed by management Provide educational sessions on error trends to coders and client teams Notify management of compliance concerns or incidents Demonstrate knowledge of HIPAA Privacy and Security Regulations through appropriate handling of patient information Promote confidentiality and discretion in handling patient information Attend educational conference calls and client meetings as required Perform other duties as assigned for the project Maintain required productivity and quality standards Maintain coding credential requirements BENEFITS: We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy. PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS: This role requires prolonged periods of desk working on a computer Talking, hearing, and near vision are required to perform computer-based tasks and virtual communications Sensory perception (visual, auditory, and tactile) is essential for computer and phone use WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS: This is a remote role; work is performed in a home office environment. e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category. Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position. Requirements: REQUIRED QUALIFICATIONS: Candidate must possess CCS Minimum 5 years' auditing experience required Recommend minimum 3 years of Trauma Level 1 and Academic Teaching facility experience Experience with CDI reconciliation and feedback, second-level reviews (audit of coder work and of vendor billing-company reviews) and resolution of Epic work queues, providing feedback & removing barriers Experience providing education/creating tip sheets Must possess strong analytical and critical-thinking abilities and strong written and verbal communication skills Must be self-motivated, organized, and able to manage multiple tasks/duties throughout the day, with comfortability adapting to evolving priorities KEY SUCCESS ATTRIBUTES: Integrity, passion, and ethics are required Demonstrates strong collaboration skills Has strong analytic and problem-solving abilities and techniques Exhibit consistent initiative with strong drive for results and success Demonstrate commitment to a team environment? Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail Ability to self-motivate and self-direct Possess strong time management and organizational skills Commitment and adherence to company Core Values CORE COMPETENCIES: High level of integrity & ethical judgement Communication Consistency and Reliability Meeting Standards
    $31k-53k yearly est. 14d ago
  • Inpatient Coding Auditor

    E4Health 3.8company rating

    Pittsburgh, PA jobs

    Job DescriptionDescription: At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do: Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth. Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day. WE GROW: We believe in win/win outcomes-when our customers win, we win. GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions. Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at ************** POSITION TITLE: Inpatient Auditor ROLE TYPE: Full Time / Part Time EMPLOYMENT TYPE: Non-Exempt JOB SUMMARY: The Inpatient Auditor is responsible for completing quality assurance reviews on internal and external inpatient coders. This includes onboarding audits and training of newly hired e4health inpatient coders. The role validates that coders accurately abstract data into client electronic medical record systems, following Official ICD-10-CM and ICD-10-PCS Guidelines, UHDDS guidelines, and CMS directives. The auditor also validates Present on Admission (POA) indicators per AHA POA guidelines and identifies missing or inappropriate provider queries. The Inpatient Auditor plays a key role in reporting quality results, tracking educational opportunities, responding to client needs, and providing educational support and training. ESSENTIAL DUTIES AND RESPONSIBILITIES: Complete scheduled quality assurance reviews for both internal teams and external client organizations Conduct onboarding audits and training for newly hired inpatient coders Deliver training sessions and educational feedback to coders, including those at client sites Communicate quality issues and audit findings to management and client contacts. Assist in drafting, implementing, and monitoring quality improvement action plans for coders Maintain reports and accuracy rates for coders and clients Respond to client QA needs and inquiries as directed by management Provide educational sessions on error trends to coders and client teams Notify management of compliance concerns or incidents Demonstrate knowledge of HIPAA Privacy and Security Regulations through appropriate handling of patient information Promote confidentiality and discretion in handling patient information Attend educational conference calls and client meetings as required Perform other duties as assigned for the project Maintain required productivity and quality standards Maintain coding credential requirements BENEFITS: We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy. PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS: This role requires prolonged periods of desk working on a computer Talking, hearing, and near vision are required to perform computer-based tasks and virtual communications Sensory perception (visual, auditory, and tactile) is essential for computer and phone use WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS: This is a remote role; work is performed in a home office environment. e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category. Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position. Requirements: REQUIRED QUALIFICATIONS: Candidate must possess an approved AHIMA coding credential Minimum 5 years' coding experience recommended; 3 years of inpatient coding in an acute care setting required Recommend minimum 3 years of Trauma Level 1 and Academic Teaching facility experience Minimum 2 years of auditing experience preferred Must be proficient at ICD-10-PCS coding KEY SUCCESS ATTRIBUTES:? Integrity, passion, and ethics are required Demonstrates strong collaboration skills Has strong analytic and problem-solving abilities and techniques Exhibit consistent initiative with strong drive for results and success Demonstrate commitment to a team environment? Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail Ability to self-motivate and self-direct Possess strong time management and organizational skills Commitment and adherence to company Core Values CORE COMPETENCIES: High level of integrity & ethical judgement Communication Consistency and Reliability Meeting Standards
    $31k-53k yearly est. 19d ago
  • Compliance Internal Auditor - Programs

    Ontario Arc 4.5company rating

    Canandaigua, NY jobs

    The Arc Ontario Internal Auditor - Programs Salary: $21.60 - $23.00 Position Overview: We're looking for an Internal Auditor to join our team and help ensure our programs meet regulatory standards and run efficiently. In this role, you'll audit billing claims, review Individual Service Plans, conduct site visits, and provide support to our Self-Advocacy Group. You'll also be responsible for maintaining audit tools, providing feedback to teams, and assisting with training and special projects as needed. In addition, you'll play a key role in preparing for outside audits and ensuring compliance with ongoing regulatory changes. If you have a keen eye for detail, enjoy problem-solving, and want to contribute to the quality and safety of our services, this role could be a great fit for you. Work Location: Canandaigua, NY Schedule: M-F 40 hours/wk with flexibility in schedule required to meet agency needs. As a full time team member at The Arc Ontario, you will receive... * Health and retirement benefits * Paid time off; Over 3 weeks of vacation within your first year! * Sick Time * Growth potential/Opportunity for advancement within my agency * Educational Assistance * Employee Assistance Program * Access to a Fitness Center in the Main Facility * Pay on Demand * Free Telehealth with EZaccessMD * Emergency Assistance Funding * And more Our Culture Investing in our staff while thriving in a flexible and fun work environment! The Arc Ontario Story: Founded in 1954 we believe that All individuals with disabilities or other challenges are one with their community. Responsibilities * Internal auditing of programs and billing claims to include aspects of compliance with documentation, accuracy of records, allowable services, quality considerations and other regulatory requirements to ensure the highest level of quality and compliance. Provides written evaluations and recommendations to programs, including recommended action plans. * Conducts site visits and observations for quality and safety. Audits Individual Satisfaction Surveys (using Therap) to ensure assigned actions are completed by appropriate staff. Follows up on past deficiencies and recommendations from OPWDD Bureau Program Certification. * Validates audit responses and forwards documentation to Compliance Officer for Corporate Compliance Committee review. Requirements * Bachelor's degree human services, business administration or related field and over three (3) years of related job experience or an equivalent combination of education and experience. * Auditing/compliance experience a plus. * Must have the ability to meet people with ease, to write and edit effectively and to communicate the written and spoken word skillfully. * Excellent computer skills and knowledge of varied computer software. * Experience with Therap preferred * Valid New York driver's license.
    $21.6-23 hourly 11d ago
  • Associate - Healthcare Compliance Auditor (Healthcare Transaction Strategy)

    Berkeley Research Group 4.8company rating

    Washington, DC jobs

    We do Consulting Differently The Associate position is a junior staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of an Associate-level Healthcare Compliance Auditor primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include payer policy research, working with team to develop audit criteria, data analysis, review of medical billing and supporting documentation, and development of client deliverables. This specific position requires an interest in medical coding and compliance, and potential candidates must have or be willing to obtain a medical coding certification within 6 months of hire. Job Responsibilities: Support client engagements and discrete segments of larger projects; Research healthcare program requirements and payer guidelines; Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance; Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines; Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicate the audit findings and recommended areas for improvement to senior members of the team; Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas; Stay current on coding guidelines. Develop analyses using transactional data and/or financial data; Make valuable contributions to client deliverables; Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions; Participate in group practice meetings; Prioritize assignments and responsibilities to meet goals and deadlines. Qualifications: An undergraduate degree in a major relevant to healthcare (Public Health, Healthcare Administration, etc.); An active coding certification (may be in apprentice status) or willingness to obtain a coding certification from either AAPC or AHIMA within 6 months of hire; An interest in medical auditing; 0-2 years of work experience that demonstrates a strong interest in the healthcare industry; Internships, fellowships, or work experience in a hospital or healthcare system preferred. Candidates with more than 3 years of experience will not be considered for this role; Preference will be given to candidates who possess some knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation; Some knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements is preferred; Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word. A desire to expand those capabilities is required. Strong attention to detail; Excellent time management, organizational skills, and ability to prioritize work and meet deadlines; Keen interest in healthcare compliance and healthcare policy; Exceptional verbal and written communication skills; Desire to work within a team environment. Associate Salary Range: $70,000 - $100,000 per year. Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship. About BRG BRG combines world-leading academic credentials with world-tested business expertise purpose-built for agility and connectivity, which sets us apart-and gets you ahead. At BRG, our top-tier professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of proven real-world experience to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges for organizations across the globe. Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking from diverse perspectives that, when paired with our global reach and resources, make us uniquely capable to address our clients' challenges. We get results because we know how to apply our thinking to your world. At BRG, we don't just show you what's possible. We're built to help you make it happen. BRG is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.
    $70k-100k yearly Auto-Apply 5d ago
  • [INTERNAL ONLY] Attendance Recovery Staff #1170

    Ingenium 3.6company rating

    Parksdale, CA jobs

    Attendance Recovery Staff Recovery opportunities: Offered after school, on Saturdays, and during Winter Break period. Students can recoup 10 days provided they were absent for 10 days. Students can make up what they missed (not in advance). Students must participate in “full day” based on minutes of instruction. Calendar: A master attendance recovery calendar will be posted on the school website, ParentSquare, and in the main office. Locations: Sessions will be hosted in classrooms. Pay: based on teacher's hourly equivalent End Date: 04/30/2026 Schedule: 8 hours bi-weekly
    $45k-73k yearly est. 60d+ ago
  • Claims Auditor

    Centivo 4.0company rating

    Buffalo, NY jobs

    We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Auditor who will be responsible for conducting pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including complex, high-dollar claims. This role plays a key part in maintaining the integrity of our claims operations by supporting all aspects of the Claims Quality Review program, establishing processing standards, responding to quality findings, assisting with performance improvement plans, and providing data to support service level agreements (SLAs). The Claims Auditor will also help ensure that audit reports are completed accurately and distributed in a timely manner. Responsibilities Include: Perform auditing of claims, ensuring processing, payment, and financial accuracy by verifying all aspects of the claim have been handled correctly and according to both standard process and the client's summary plan description. Completes reporting of audits finalized with decision methodology for procedural and monetary errors, which are used for quality reporting and trending analysis utilizing QA tools. Responsible to communicate corrections and adjustments to Examiners as identified on pre-payment audits, including high dollar claims, and to verify corrections and adjustments are complete and accurate. Identify and escalate trends based on the quality reviews. Confer with Claims QA Lead, Claims Supervisors, Claim Managers, and/or Training Lead on any problematic issues warranting immediate corrective action. May investigate and research issues as required to create or improve standard processing guidelines and may participate in projects as a subject matter expert as needed. Perform any other additional tasks as necessary, including processing of claims, creating policies, training, and/or mentoring examiners through quality improvement plans. Qualifications: Required Skills and Abilities: Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred. Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines. Strong analytical, organizational, and interpersonal skills, with the ability to communicate effectively with others. Attention to details, organized, quality and productivity driven. Education and Experience: High School diploma or GED required. Associate or bachelor's degree preferred. Minimum of three (3) years of experience as a claim examiner and/or auditor with self-funded health care plans and processing in a TPA environment, meeting production and quality goals/ standards. Proficient experience in MS Word, Excel, Outlook, and PowerPoint required. Preferred Qualifications: Ability to acquire and perform progressively more complex skills and tasks in a production environment. Ability to work under limited supervision and provide guidance and coaching to others. Excellent coaching skills and ability to mentor others towards quality improvement. Work Location: Candidates located within commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. All other applicants will be considered for remote positions. Centivo Values: Resilient - This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don't give up. Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon. Positive - We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
    $42k-61k yearly est. Auto-Apply 10d ago
  • Internal Auditor

    Aligned Solutions 4.3company rating

    Miami, FL jobs

    Aligned Solutions is seeking a Senior Internal Auditor for a well respected company. The Internal Auditor should have SOX experience for this publicly traded company. DUTIES & RESPONSIBILITIES: The ideal candidate will possess a broad skill set and have the capacity for learning required to audit various accounting and operational environments. The responsibilities that you will be given will make the most of your strengths and challenge you to develop even further in a supportive, team-focused atmosphere. Duties will include: Conducting financial, operational and internal controls (Sarbanes-Oxley) audits of the company and its subsidiaries. More specifically: Internal Controls - Assess the adequacy in the design of the company's internal controls and test the existence of these controls in the following areas: Order to Cash Cycle (Revenue, Shipping, Invoicing & Customer Payments); Purchase to Pay Cycle (Purchasing, Receiving & Vendor Payments); Financial Reporting, Human Resources, Inventory, Fixed Assets; Taxes, Selling & Marketing and Manage Risk (Investments and Financial Commitments) Financial -- Audit subsidiary financial results each quarter to ensure financial statements are prepared and presented consistent with Generally Accepted Accounting Principles and are free from material error Operational -- perform risk-based audits of subsidiary HQ and store locations to improve operational efficiency, effectiveness, and/or profitability Recommending real world, practical solutions to improve efficiency and/or effectiveness with the goal of reducing risk, improving internal controls and/or improving profitability Maintaining detailed audit work papers to support all audit findings and recommendations Managing multiple tasks within a deadline-oriented environment Reporting audit findings and recommendations to the Vice President of Internal Audit and various levels of management The ideal candidate will be a professional who: Can effectively manage multiple tasks and deadlines; Is self-motivated and takes pride in the results of their efforts; Enjoys variety in the tasks performed; and Enjoys an environment of empowerment and responsibility. And here is what you will need to be successful: EXPERIENCE & QUALIFICATIONS: The ideal candidate should have the following: Strong analytical skills with an ability to identify real world, practical solutions in an ever changing, dynamic environment A strong technical knowledge of Generally Accepted Accounting Principles and Generally Accepted Auditing Standards Hands on experience with Sarbanes Oxley/Internal Controls. A degree in accounting Very strong interpersonal and time management skills Proficiency with the Microsoft Office suite of products, (i.e. Word, Excel, PowerPoint) CIA and/or CPA certifications preferred but not required Willingness to travel (approximately 25%) throughout United States with limited travel to Canada and Mexico Must be eligible to work without current or future sponsorship in the USA
    $49k-71k yearly est. 60d+ ago
  • Financial Audit Senior

    Draftkings 4.0company rating

    Boston, MA jobs

    At DraftKings, AI is becoming an integral part of both our present and future, powering how work gets done today, guiding smarter decisions, and sparking bold ideas. It's transforming how we enhance customer experiences, streamline operations, and unlock new possibilities. Our teams are energized by innovation and readily embrace emerging technology. We're not waiting for the future to arrive. We're shaping it, one bold step at a time. To those who see AI as a driver of progress, come build the future together. The Crown Is Yours As a Financial Audit Senior on our Internal Audit team, you will be part of a dynamic and expanding group dedicated to enhancing our Sarbanes-Oxley (SOX) compliance and internal audit initiatives in a complex, highly regulated environment. Leveraging your financial auditing experience, along with exceptional communication and project management skills, you will build strong stakeholder relationships while driving the execution of critical audit initiatives. What you'll do as an Financial Audit Senior * Document and report results from the enterprise risk assessment. * Update SOX process documentation and risk/control matrices to reflect the current environment. * Assess processes and controls for new acquisitions, product lines, and locations added to SOX scope to identify potential improvements. * Conduct ongoing SOX scoping to evaluate changes in business processes or systems and participate in follow-up procedures to verify the implementation of remediation actions. * Perform detailed testing for the annual SOX program in collaboration with external auditors. * Assist with preparing and documenting annual materiality and planning analyses to support SOX program scope. * Conduct operational audits and risk/compliance assessments. * Provide regular updates on SOX testing status and deliver oral and written audit findings to management, recommending corrective actions and process improvements. * Foster strong relationships with external auditors and internal stakeholders (e.g., Accounting, Finance, Tax, HR, Legal, Product Operations) to address SOX-related matters, facilitate requests, and monitor testing progress. What you'll bring * At least 3 years of related Audit experience is required, ideally within the Big 4. * Bachelor's degree is required, CPA, CA, CISA, or CIA certification is preferred. * Strong attention to detail, proactive mindset, and organizational skills to efficiently process and summarize large volumes of information. * Ability to manage multiple tasks and projects, balancing large and small initiatives simultaneously. * Excellent verbal and written communication skills, with the ability to convey complex concepts clearly to all management levels and effectively resolve conflicts. * Located in Boston, MA, with the ability to travel, both domestically and internationally, up to 15% of the time. #LI-AW1 Join Our Team We're a publicly traded (NASDAQ: DKNG) technology company headquartered in Boston. As a regulated gaming company, you may be required to obtain a gaming license issued by the appropriate state agency as a condition of employment. Don't worry, we'll guide you through the process if this is relevant to your role. The US base salary range for this full-time position is 84,600.00 USD - 105,800.00 USD, plus bonus, equity, and benefits as applicable. Our ranges are determined by role, level, and location. The compensation information displayed on each job posting reflects the range for new hire pay rates for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific pay range and how that was determined during the hiring process. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
    $42k-66k yearly est. Auto-Apply 5d ago
  • Finance Audit Staff

    Draftkings 4.0company rating

    Boston, MA jobs

    At DraftKings, AI is becoming an integral part of both our present and future, powering how work gets done today, guiding smarter decisions, and sparking bold ideas. It's transforming how we enhance customer experiences, streamline operations, and unlock new possibilities. Our teams are energized by innovation and readily embrace emerging technology. We're not waiting for the future to arrive. We're shaping it, one bold step at a time. To those who see AI as a driver of progress, come build the future together. The Crown Is Yours As a Finance Audit Staff on our Internal Audit team, you will be part of a dynamic and expanding group dedicated to enhancing our Sarbanes-Oxley (SOX) compliance and internal audit initiatives in a complex, highly regulated environment. Leveraging your financial auditing experience, along with exceptional communication and project management skills, you will build strong stakeholder relationships while driving the execution of critical audit initiatives. What you'll do as a Finance Audit Staff Assist with walkthroughs and testing of business process controls for the annual SOX program in collaboration with senior auditors and external auditors. Help maintain SOX documentation including process narratives, control descriptions, risk and control matrices, and testing workpapers. Contribute to ongoing SOX scoping activities by assessing changes in systems, applications, or business processes. Assess processes and controls for new acquisitions, product lines, and locations added to SOX scope to identify potential improvements. Conduct operational audits and risk/compliance assessments. Draft accurate and well organized workpapers that support audit conclusions and assist with preparing reports that summarize findings and recommendations. Provide regular updates on SOX testing status and deliver oral and written audit findings to management, recommending corrective actions and process improvements. Foster strong relationships with external auditors and internal stakeholders (e.g., Accounting, Finance, Tax, HR, Legal, Product Operations) to address SOX-related matters, facilitate requests, and monitor testing progress. Participate in follow-up procedures to verify the implementation of remediation actions. What you'll bring At least 1 year of related Audit experience is required, ideally within the Big 4. Bachelor's degree in Accounting, Finance, Business Administration, or a related field. Strong attention to detail combined with analytical abilities to evaluate information and identify potential issues. Effective organizational skills with the ability to manage multiple tasks in a fast-paced environment. Clear and professional verbal and written communication skills with the ability to document results and collaborate with teams across the organization. Curiosity, initiative, and a desire to learn from senior team members while developing both audit and technical skills. Proficiency with Microsoft Office and interest in learning audit tools, data analysis platforms, or technology systems. Proficiency with Audit Board is a plus. Located in Boston, MA, with the ability to travel, both domestically and internationally, up to 15% of the time. #LI-AW1 Join Our Team We're a publicly traded (NASDAQ: DKNG) technology company headquartered in Boston. As a regulated gaming company, you may be required to obtain a gaming license issued by the appropriate state agency as a condition of employment. Don't worry, we'll guide you through the process if this is relevant to your role. The US base salary range for this full-time position is 68,000.00 USD - 85,000.00 USD, plus bonus, equity, and benefits as applicable. Our ranges are determined by role, level, and location. The compensation information displayed on each job posting reflects the range for new hire pay rates for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific pay range and how that was determined during the hiring process. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
    $42k-66k yearly est. Auto-Apply 6d ago
  • Finance Audit Senior

    Draftkings 4.0company rating

    Boston, MA jobs

    At DraftKings, AI is becoming an integral part of both our present and future, powering how work gets done today, guiding smarter decisions, and sparking bold ideas. It's transforming how we enhance customer experiences, streamline operations, and unlock new possibilities. Our teams are energized by innovation and readily embrace emerging technology. We're not waiting for the future to arrive. We're shaping it, one bold step at a time. To those who see AI as a driver of progress, come build the future together. The Crown Is Yours As a Finance Audit Senior on our Internal Audit team, you will be part of a dynamic and expanding group dedicated to enhancing our Sarbanes-Oxley (SOX) compliance and internal audit initiatives in a complex, highly regulated environment. Leveraging your financial auditing experience, along with exceptional communication and project management skills, you will build strong stakeholder relationships while driving the execution of critical audit initiatives. What you'll do as an Finance Audit Senior Document and report results from the enterprise risk assessment. Update SOX process documentation and risk/control matrices to reflect the current environment. Assess processes and controls for new acquisitions, product lines, and locations added to SOX scope to identify potential improvements. Conduct ongoing SOX scoping to evaluate changes in business processes or systems and participate in follow-up procedures to verify the implementation of remediation actions. Perform detailed testing for the annual SOX program in collaboration with external auditors. Assist with preparing and documenting annual materiality and planning analyses to support SOX program scope. Conduct operational audits and risk/compliance assessments. Provide regular updates on SOX testing status and deliver oral and written audit findings to management, recommending corrective actions and process improvements. Foster strong relationships with external auditors and internal stakeholders (e.g., Accounting, Finance, Tax, HR, Legal, Product Operations) to address SOX-related matters, facilitate requests, and monitor testing progress. What you'll bring At least 3 years of related Audit experience is required, ideally within the Big 4. Bachelor's degree is required, CPA, CA, CISA, or CIA certification is preferred. Strong attention to detail, proactive mindset, and organizational skills to efficiently process and summarize large volumes of information. Ability to manage multiple tasks and projects, balancing large and small initiatives simultaneously. Excellent verbal and written communication skills, with the ability to convey complex concepts clearly to all management levels and effectively resolve conflicts. Located in Boston, MA, with the ability to travel, both domestically and internationally, up to 15% of the time. #LI-AW1 Join Our Team We're a publicly traded (NASDAQ: DKNG) technology company headquartered in Boston. As a regulated gaming company, you may be required to obtain a gaming license issued by the appropriate state agency as a condition of employment. Don't worry, we'll guide you through the process if this is relevant to your role. The US base salary range for this full-time position is 84,600.00 USD - 105,800.00 USD, plus bonus, equity, and benefits as applicable. Our ranges are determined by role, level, and location. The compensation information displayed on each job posting reflects the range for new hire pay rates for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific pay range and how that was determined during the hiring process. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
    $42k-66k yearly est. Auto-Apply 5d ago
  • IT Audit Staff

    Draftkings 4.0company rating

    Boston, MA jobs

    At DraftKings, AI is becoming an integral part of both our present and future, powering how work gets done today, guiding smarter decisions, and sparking bold ideas. It's transforming how we enhance customer experiences, streamline operations, and unlock new possibilities. Our teams are energized by innovation and readily embrace emerging technology. We're not waiting for the future to arrive. We're shaping it, one bold step at a time. To those who see AI as a driver of progress, come build the future together. The Crown Is Yours As a IT Audit Staff you will support technology focused Internal Audit activities and our Sarbanes Oxley (SOX) compliance program in a complex and highly regulated environment. This role provides hands-on experience with IT controls, risk assessments, audit testing, and reporting. You will build foundational audit skills, gain exposure to core systems and processes that support our products, and contribute to strengthening our technology control environment. What you will do as a IT Audit, Staff Assist with walkthroughs and testing of IT controls for the annual SOX program in collaboration with senior auditors and external auditors. Help maintain SOX documentation including process narratives, control descriptions, risk and control matrices, and testing workpapers. Contribute to ongoing SOX scoping activities by assessing changes in systems, applications, infrastructure, or business processes. Execute audit and follow up procedures for technology and operational audits under the guidance of senior team members Participate in assessments of new products, system enhancements, or acquisitions added to SOX scope and help identify potential control gaps or improvement opportunities. Draft accurate and well organized workpapers that support audit conclusions and assist with preparing reports that summarize findings and recommendations. Coordinate with stakeholders in Technology, Product, Engineering, Security, Accounting, and other areas to obtain documentation and understand processes. Support external auditor requests and help ensure timely responses that enable reliance on internal testing and reduce business disruption. What you will bring At least 1 year of related Audit experience is required, ideally within the Big 4. Bachelor's degree in Information Systems, Accounting, Finance, Computer Science, Business Administration, or a related field. Strong attention to detail combined with analytical abilities to evaluate information and identify potential issues. Effective organizational skills with the ability to manage multiple tasks in a fast paced environment. Clear and professional verbal and written communication skills with the ability to document results and collaborate with teams across the organization. Curiosity, initiative, and a desire to learn from senior team members while developing both audit and technical skills. Proficiency with Microsoft Office and interest in learning audit tools, data analysis platforms, or technology systems. Proficiency with AuditBoard is a plus. Located in Boston, MA, with the ability to travel, both domestically and internationally, up to 15% of the time. #LI-AW1 Join Our Team We're a publicly traded (NASDAQ: DKNG) technology company headquartered in Boston. As a regulated gaming company, you may be required to obtain a gaming license issued by the appropriate state agency as a condition of employment. Don't worry, we'll guide you through the process if this is relevant to your role. The US base salary range for this full-time position is 68,000.00 USD - 85,000.00 USD, plus bonus, equity, and benefits as applicable. Our ranges are determined by role, level, and location. The compensation information displayed on each job posting reflects the range for new hire pay rates for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific pay range and how that was determined during the hiring process. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
    $65k-93k yearly est. Auto-Apply 6d ago
  • Senior Auditor

    Northeastern University 4.5company rating

    Boston, MA jobs

    About the Opportunity Northeastern University's Audit & Advisory Services is seeking a motivated and talented individual to join our team as a Senior Auditor. This is an exciting opportunity to join our team of skilled professionals that work collaboratively throughout the University as a trusted partner. The team consistently delivers value-adding, high-quality results in a challenging and fast-paced environment. JOB SUMMARY Reporting to the Associate Director - Audit, the Senior Auditor will participate in all phases of assigned audits, from planning to reporting. They will undertake a range of challenging audit work, including leading and executing audits and advisory projects. The Senior Auditor is responsible for assessing, evaluating and making recommendations to management regarding the effectiveness of its risk management, governance, and the system of internal controls inherent in the processes and activities of the University. In this capacity, the Senior Auditor is familiar with the mission of the University and generates value-added recommendations that enhance the University's overall operations. Our integrated auditing model will provide the Senior Auditor with opportunities to plan and execute both information technology (IT) and operational audit projects designed to provide assessment of internal control processes and operational performance. * Applicants must be authorized to work in the United States. The University is unable to work sponsor for this role, now or in the future MINIMUM QUALIFICATIONS Understanding of internal auditing standards, COSO, and risk assessment practices, IT and audit principles and awareness of ISACA or IIA standards for the Professional Practice of Internal Auditing Proficient with Microsoft Office applications including Word, Excel, Power Point, and Visio Experience with data visualization tools (e.g., Tableau, Power BI) and/or SAS programming language for data extraction and manipulation is preferred but not required Excellent oral and written communication skills, effective report writing and presentations Project management skills with demonstrated experience in meeting project timelines and deliverables and the ability to handle multiple project assignments simultaneously Demonstrated ability to work independently and as part of a project team High degree of professionalism, integrity, and accountability Strong analytical and problem-solving skills Three or more years of experience in public accounting, auditing, compliance, or risk management Knowledge and skills required for this position are normally acquired through a bachelor's degree in business administration, accounting, or a related field KEY RESPONSIBILITIES & ACCOUNTABILITIES Provides professional audit work, individually or as a team leader, in conducting reviews of assigned organizational activities in accordance with IIA and department standards Plans and executes audit projects designed to provide assessment of internal control processes and operational performance Prepares detailed plans for performing individual audits including the identification of key risks and controls, determination of audit objectives, and development of an appropriate audit program Uses knowledge of the current environment and industry trends to identify potential issues and risks Under minimal supervision, develops clear, concise, accurate and complete work papers to support findings and recommendations, and writes clear and concise reports for management Assist in developing data analytics procedures for performing and optimizing routine audit tasks Performs or assists in the performance of special projects or studies, including risk assessments, fraud investigations, system pre-implementation assessments, and acquisition due diligence reviews Works with external auditors, as necessary Position Type Legal and Regulatory Administration Additional Information Northeastern University considers factors such as candidate work experience, education and skills when extending an offer. Northeastern has a comprehensive benefits package for benefit eligible employees. This includes medical, vision, dental, paid time off, tuition assistance, wellness & life, retirement- as well as commuting & transportation. Visit ************************************* for more information. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to race, religion, color, national origin, age, sex, sexual orientation, disability status, or any other characteristic protected by applicable law. Compensation Grade/Pay Type: 109S Expected Hiring Range: $66,850.00 - $94,427.50 With the pay range(s) shown above, the starting salary will depend on several factors, which may include your education, experience, location, knowledge and expertise, and skills as well as a pay comparison to similarly-situated employees already in the role. Salary ranges are reviewed regularly and are subject to change.
    $66.9k-94.4k yearly Auto-Apply 15d ago
  • Financial Audit Specialist

    Draftkings 4.0company rating

    Boston, MA jobs

    At DraftKings, AI is becoming an integral part of both our present and future, powering how work gets done today, guiding smarter decisions, and sparking bold ideas. It's transforming how we enhance customer experiences, streamline operations, and unlock new possibilities. Our teams are energized by innovation and readily embrace emerging technology. We're not waiting for the future to arrive. We're shaping it, one bold step at a time. To those who see AI as a driver of progress, come build the future together. The Crown Is Yours As a Financial Audit Specialist on our Internal Audit team, you will be part of a dynamic and expanding group dedicated to enhancing our Sarbanes-Oxley (SOX) compliance and internal audit initiatives in a complex, highly regulated environment. Leveraging your financial auditing experience, along with exceptional communication and project management skills, you will build strong stakeholder relationships while driving the execution of critical audit initiatives. What you'll do as a Financial Audit Specialist * Assist with walkthroughs and testing of business process controls for the annual SOX program in collaboration with senior auditors and external auditors. * Help maintain SOX documentation including process narratives, control descriptions, risk and control matrices, and testing workpapers. * Contribute to ongoing SOX scoping activities by assessing changes in systems, applications, or business processes. * Assess processes and controls for new acquisitions, product lines, and locations added to SOX scope to identify potential improvements. * Conduct operational audits and risk/compliance assessments. * Draft accurate and well organized workpapers that support audit conclusions and assist with preparing reports that summarize findings and recommendations. * Provide regular updates on SOX testing status and deliver oral and written audit findings to management, recommending corrective actions and process improvements. * Foster strong relationships with external auditors and internal stakeholders (e.g., Accounting, Finance, Tax, HR, Legal, Product Operations) to address SOX-related matters, facilitate requests, and monitor testing progress. * Participate in follow-up procedures to verify the implementation of remediation actions. What you'll bring * At least 1 year of related Audit experience is required, ideally within the Big 4. * Bachelor's degree in Accounting, Finance, Business Administration, or a related field. * Strong attention to detail combined with analytical abilities to evaluate information and identify potential issues. * Effective organizational skills with the ability to manage multiple tasks in a fast-paced environment. * Clear and professional verbal and written communication skills with the ability to document results and collaborate with teams across the organization. * Curiosity, initiative, and a desire to learn from senior team members while developing both audit and technical skills. * Proficiency with Microsoft Office and interest in learning audit tools, data analysis platforms, or technology systems. * Proficiency with Audit Board is a plus. * Located in Boston, MA, with the ability to travel, both domestically and internationally, up to 15% of the time. Join Our Team We're a publicly traded (NASDAQ: DKNG) technology company headquartered in Boston. As a regulated gaming company, you may be required to obtain a gaming license issued by the appropriate state agency as a condition of employment. Don't worry, we'll guide you through the process if this is relevant to your role. The US base salary range for this full-time position is 68,000.00 USD - 85,000.00 USD, plus bonus, equity, and benefits as applicable. Our ranges are determined by role, level, and location. The compensation information displayed on each job posting reflects the range for new hire pay rates for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific pay range and how that was determined during the hiring process. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
    $17k-42k yearly est. Auto-Apply 6d ago

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