Auditor jobs at Northwell Health - 256 jobs

**Our promise to you:** Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **All the benefits and perks you need for you and your family:** + Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance + Paid Time Off from Day One + 403-B Retirement Plan + 4 Weeks 100% Paid Parental Leave + Career Development + Whole Person Well-being Resources + Mental Health Resources and Support + Pet Benefits **Schedule:** Full time **Shift:** Day (United States of America) **Address:** 601 E ROLLINS ST **City:** ORLANDO **State:** Florida **Postal Code:** 32803 **Job Description:** **Schedule:** Full Time **Shift** : Days Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization's reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. **The expertise and experiences you'll need to succeed:** **QUALIFICATION REQUIREMENTS:** High School Grad or Equiv (Required), Technical/Vocational SchoolCertified Coding Specialist (CCS) - EV Accredited Issuing Body, Certified Professional Coder (CPC) - EV Accredited Issuing Body, Registered Health Information Administrator (RHIA) - EV Accredited Issuing Body, Registered Health Information Technician (RHIT) - EV Accredited Issuing Body **Pay Range:** $26.29 - $48.91 _This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances._ **Category:** Health Information Management **Organization:** AdventHealth Orlando Support **Schedule:** Full time **Shift:** Day **Req ID:** 150658628

Our promise to you: Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: * Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance * Paid Time Off from Day One * 403-B Retirement Plan * 4 Weeks 100% Paid Parental Leave * Career Development * Whole Person Well-being Resources * Mental Health Resources and Support * Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 601 E ROLLINS ST City: ORLANDO State: Florida Postal Code: 32803 Job Description: Schedule: Full Time Shift: Days Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization's reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. The expertise and experiences you'll need to succeed: QUALIFICATION REQUIREMENTS: High School Grad or Equiv (Required), Technical/Vocational SchoolCertified Coding Specialist (CCS) - EV Accredited Issuing Body, Certified Professional Coder (CPC) - EV Accredited Issuing Body, Registered Health Information Administrator (RHIA) - EV Accredited Issuing Body, Registered Health Information Technician (RHIT) - EV Accredited Issuing Body Pay Range: $26.29 - $48.91 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Align with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals. **What you be doing in this role:** The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated with documentation, coding, and billing. This position is responsible for maintaining expert knowledge and understanding of coding and documentation guidelines. Collaboration with the Manager of Audit and Compliance and others where expertise in compliant coding and documentation is needed. In this role your duties will include: + Performs physician compliance audits and group audits by analyzing medical record documentation and coding services to ensure compliance with government and organizational policies and procedures. + Identifies areas of risk and/or non-compliance and provides recommendations for action - advances as needed. + Conducts education and training sessions with individual providers on audit finding results, regulatory requirements and provide actionable feedback for improvement. + Responsible for summarizing audits results and presenting to provider, operations leaders, other leadership. + Communicates feedback directly to providers. + Prepares necessary reports and communicates audit results to management and clinicians. + Prepares training and education materials acting as subject matter expert. + Tracks, records, and maintains audit/review activity in software or excel spreadsheets. + Provides regular and ad hoc reporting. + Assists with audit & compliance related special projects as requested. + Maintains a high level of competency related to medical record documentation, coding and compliance with government regulations by attending appropriate workshops and seminars. + Monitors Medicare and regulatory agencies rules for updates and changes and supports CSMN's core values and procedures. + Acts as a professional liaison for physician compliance related activities, in a professional and confidential manner. **Qualifications** **Requirements:** High school diploma or GED required. Bachelor's degree preferred. Certified Professional Coder certification required upon hire. A minimum of 2 years of professional fee coding/auding required, preferably in an academic medical setting. **Why work here?** We take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation. **Req ID** : 13920 **Working Title** : Physician Coding Compliance Auditor **Department** : CSRC PB Rev Integrity and CDM **Business Entity** : Cedars-Sinai Medical Center **Job Category** : Patient Financial Services **Job Specialty** : Revenue Integrity **Overtime Status** : NONEXEMPT **Primary Shift** : Day **Shift Duration** : 8 hour **Base Pay** : $37.03 - $57.40 Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

Align with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals. What you be doing in this role: The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated with documentation, coding, and billing. This position is responsible for maintaining expert knowledge and understanding of coding and documentation guidelines. Collaboration with the Manager of Audit and Compliance and others where expertise in compliant coding and documentation is needed. In this role your duties will include: Performs physician compliance audits and group audits by analyzing medical record documentation and coding services to ensure compliance with government and organizational policies and procedures. Identifies areas of risk and/or non-compliance and provides recommendations for action - advances as needed. Conducts education and training sessions with individual providers on audit finding results, regulatory requirements and provide actionable feedback for improvement. Responsible for summarizing audits results and presenting to provider, operations leaders, other leadership. Communicates feedback directly to providers. Prepares necessary reports and communicates audit results to management and clinicians. Prepares training and education materials acting as subject matter expert. Tracks, records, and maintains audit/review activity in software or excel spreadsheets. Provides regular and ad hoc reporting. Assists with audit & compliance related special projects as requested. Maintains a high level of competency related to medical record documentation, coding and compliance with government regulations by attending appropriate workshops and seminars. Monitors Medicare and regulatory agencies rules for updates and changes and supports CSMN's core values and procedures. Acts as a professional liaison for physician compliance related activities, in a professional and confidential manner. Qualifications Requirements: High school diploma or GED required. Bachelor's degree preferred. Certified Professional Coder certification required upon hire. A minimum of 2 years of professional fee coding/auding required, preferably in an academic medical setting. Why work here? We take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation. Req ID : 13920 Working Title : Physician Coding Compliance Auditor Department : CSRC PB Rev Integrity and CDM Business Entity : Cedars-Sinai Medical Center Job Category : Patient Financial Services Job Specialty : Revenue Integrity Overtime Status : NONEXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : $37.03 - $57.40

Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, and federal and state regulations and guidelines. The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff and provides physician and coder education. The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs and will serve as an institutional subject matter expert and authoritative resource. The Ideal Candidate Will Have The: Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties. Ability to work in both independent contributor and team roles (both as a team leader and team member) Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership. Responsibilities: Plans and performs scheduled and unscheduled professional or hospital compliance department audits, including accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews. Evaluates the appropriateness of services and procedures billed based on supporting documentation. Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices. Develops compliance training content and provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others. Conducts compliance orientation training for new providers. Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations. Serves as institutional subject matter expert and authoritative resource in these areas. Credentials and Qualifications: Bachelor's degree in Health Information Management, Business or related field. Three (3) years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work. **In lieu of a bachelor's degree, HS Diploma/GED and seven (7) years of relevant experience will be considered. Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.). Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing. Knowledge of Medicare and Medicaid documentation and coding rules and guidelines. Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation. Preferred: Professional and/or hospital services auditing experience in an Academic Medical Center. Prior experience working in a Corporate Compliance environment. Prior experience working in a Cancer Hospital. Prior experience working in a Revenue Cycle Operations role. Knowledge of Soarian and/or Soarian PRM applications. Knowledge of Cerner Powerchart applications.

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

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

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

The Internal Audits Division Auditor conducts internal audits to monitor the adherence of various department processes to regulatory requirements. These departments include Utilization Management (UM), Case Management (CM), Member Services (MS), Pharmacy, Enhanced Care Management and Community Supports (ECM/CS), and Grievance and Appeals (G&A). The auditor evaluates compliance with established management control systems, policies, procedures, and regulatory standard requirements. They provide analysis, findings, results, and recommendations to the Internal Audits Division Manager. The auditors report directly to the Internal Audits Division Manager, who reports to the Chief Operations Officer (COO). Compliance with Regulations Works closely with all necessary departments or entities to verify that the processes, programs, and services are completed in a quality, timely, and efficient manner, in accordance with CHG policies and procedures, and in compliance with applicable state and federal regulations, contractual requirements, and accrediting bodies. The internal Audits Division team follows regulatory audit processes, including conducting exit interview meetings to present results and findings to the corresponding management team, issuing Corrective Action Plans (CAPs) as needed, and following up on CAPs. Uses NCQA's 8/30 model for sampling methodology. Responsibilities Regulatory Knowledge: In-depth understanding or working knowledge of Department of Healthcare Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and Department of Managed Healthcare (DMHC), and other regulatory agencies as it relates to regulatory requirements related to UM, CM, MS, Pharmacy, ECM/CS, and G&A. Departmental Policies: In-depth understanding of the policies and procedures, desktop processes, and best practice guides used by the UM, CM, MS, Pharmacy, ECM/CS, and G&A departments. Implements and maintains established audit/control systems to ensure policies and procedures are met. Documents and maintains records of all audits performed, including raw data or files reviewed, report of findings, corrective action plans, reassessment, and any ongoing monitoring logs. Investigates, reviews, and analyzes data related to UM, CM, MS, Pharmacy, ECM/CS, and G&A by applying knowledge of established policies and regulatory guidelines to improve department audit preparedness. Inputs audit data into an audit scoring tool, reports findings, and recommends corrective action. Reports any audit concerns to the supervisor without delay. Provides recommendations for staff training based on audit findings and potential risks. Reassesses a deficiency after a corrective action has been implemented and conducts ongoing monitoring to ensure that the deficiency does not reoccur. In concert with department management, assists in preparation of documents for any external or internal audits and accreditation surveys. Assists in the development of new audit methodology and scope on an as-needed basis. Stays up to date with all relevant changes to state and federal regulations, contractual requirements, and accreditation standards. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies. Contributes to the team effort by accomplishing related results as needed. Maintains company reputation and contributes to the team effort by conveying a professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested. Performs other duties as assigned. Qualifications Education and Experience Bachelor's degree in a healthcare-related field is required. Two or more years in a managed care setting, with at least one year of experience in an auditing role (preferably in the healthcare industry). Solid healthcare and managed care background with knowledge of Medi-Cal and Medicare guidelines. Proficiency in Microsoft Office: Word, Excel, PowerPoint, and Outlook. Knowledge of QNXT and related software applications; ability to navigate internal data and systems. Excellent verbal and written communication skills, strong analytical abilities, and interpersonal skills. Excellent organizational skills with the ability to handle multiple tasks and/or projects simultaneously, prioritize work effectively, and demonstrate superior attention to detail. Ability to handle confidential, sensitive information with professionalism. Ability to retrieve information from various sources, analyze it effectively, and apply mature, independent judgment. Strong agility and adaptability to changing regulations, timelines, and requirements. Problem-solving skills with the ability to look for root causes and implementable, workable solutions. Auditing of pharmacy department activities may require a Certified Pharmacy Technician with an Active California Pharmacy Technician license. Physical Requirements Prolonged periods of sitting. Prolonged use of a computer. May be required to work evenings, weekends, and holidays. Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action

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

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

About the Role We are seeking a detail-oriented and analytical Internal Auditor to join our team and perform audits across multiple operational areas, including health plan claims operations, finance, compliance, clinical services, and IT. This role is critical in ensuring enterprise-wide compliance, operational efficiency, and strong internal controls. The Internal Auditor will conduct independent reviews, assess risks, and provide actionable recommendations to strengthen processes and mitigate potential issues. Key Responsibilities Develop and execute risk-based audit plans covering multiple operational areas (claims, finance, compliance, clinical, IT). Evaluate internal controls related to health plan claims, financial reporting, regulatory compliance, and operational processes. Perform audits to identify control gaps, operational inefficiencies, and potential fraud risks across departments. Review adherence to company policies, procedures, and industry best practices. Prepare comprehensive audit reports detailing findings, recommendations, and corrective actions. Collaborate with leadership teams across departments to implement improvements. Monitor remediation efforts and follow up on audit recommendations. Maintain documentation in accordance with professional auditing standards (IIA).

Department: Health Information Management Shift Details: Monday to Friday, Days. This is a remote position and is only open to candidates in Florida. Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals. Summary The HIM Coding/Compliance Auditor 2 analyzes abstracted, coded data for the purpose of ensuring coding accuracy. Serves as a resource for expert knowledge in coding and documentation requirements. Performs coding audits on inpatient and outpatients coders, reviews SMART edits, external coding audits, claim denials and audits from insurance companies, as well as, any other coding audits. Works very closely with the CDI Department. Must be an expert on ICD-9 and CPT Coding systems. Must have ICD-10 knowledge. Responsibilities * Performs Internal Coding Audits on inpatient and outpatient coders providing feedback and re-training as required. * Reviews findings from External Coding Audits for validity of DRG assignment and provide responses if there is a disagreement. * Discusses findings and any discrepancies in coding accuracy with external vendor, citing Coding Guidelines and coding Clinics. * Perform SMART edit reviews and educate the internal coders on their errors. * Review and respond to email requests from the CBO for DRG validation, missing procedure codes, Discharge Status discrepancies and Present on Admission assignments. * Provide responses to inquires from insurance companies regarding accuracy in codes used by the facility. * Reviews claim denials/audits from insurance companies. * Provide education and guidance to the CDI team and the inpatient and outpatient coding staff, reviewing diagnoses and/or procedures that require clarifications. * Annual coding updates are reviewed at these sessions, as well as, Coding Guidelines and Coding Clinics. * Works with the Rehabilitation Teams from Jackson Main and Jackson North reviewing and advising on concurrent coding worksheets. * Works with the CBO and the Revenue Cycle Team providing DRG validation and correcting accounts with missing or incorrect coding. * Provides feedback to the coder involved in each case. * entering coding for in-house patients as per CBO request. * Works closely with the CDI Team including concurrent DRG validation; provides assistance with assigning DRG's to in-house patients and provides individual guidance and education in applying Coding Guidelines. * Works with different services educating them on appropriate documentation to support the severity of the patient's condition. Neonatology Team, Burn Center, etc Experience * Generally requires 5 to 7 years of related experience. * Prior coding experience is highly preferred Education * High school diploma is required. * Bachelor's degree in related field is strongly preferred. Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.

Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all. The Compliance Auditor supports Marin Community Clinics' compliance, risk management, and quality programs by performing independent audits, monitoring activities, and data validation to ensure adherence to federal and state regulations. This includes HRSA Health Center Program requirements, FTCA, CMS billing and documentation rules, Medi-Cal, TJC standards, HIPAA/HITECH, 42 CFR Part 2, California health laws, and internal policies. The role works closely with clinical, operational, billing, dental, behavioral health, specialty, and administrative teams to identify gaps, validate corrective actions, ensure MCC is audit ready, and ensure continuous improvement in compliance, quality, and patient safety. Responsibilities Compliance Auditing & Monitoring * Conduct audits across medical, dental, behavioral health, specialty, and billing workflows. * Evaluate documentation, coding, billing accuracy, and alignment with CMS, Medi-Cal, and HRSA requirements. * Audit privacy/security compliance (HIPAA, HITECH, 42 CFR Part 2), telehealth consent, and minimum necessary requirements. * Perform FTCA-related audits, including credentialing/privileging, QI, incident reporting, and OB risk processes. * Review compliance with TJC standards and adherence to California laws and regulations. Regulatory & Policy Compliance * Audit adherence to internal policies, workflows, and operational procedures. * Incorporate regulatory updates (OIG, CMS, HRSA, and California) into audit tools. * Support HRSA Site Visit Protocol (SVP) monitoring. Data Review & Reporting * Develop audit tools and sampling methodologies. * Produce clear audit reports outlining findings, trends, risk levels, and recommendations. * Present results to leadership and committees; track corrective actions. Risk Identification & Mitigation * Identify regulatory, financial, operational, and clinical risks and escalate issues appropriately. * Recommend corrective action that support Just Culture and patient safety. * Participate in root cause analysis (RCA) and after-action reviews. Training, Education & Technical Support * Provide targeted feedback and education based on audit findings. * Support development of compliance training modules and department workflows. Continuous Quality Improvement * Validate quality measure documentation (UDS, HEDIS, CalAIM, dental and behavioral health metrics) and workflow adherence. * Support performance improvement plans and monitor sustainability. Additional Duties * Maintain audit logs, dashboards, CAP tracking, and trend reports. * Support compliance hotline review, investigations, and regulatory survey preparation (HRSA, OSV, TJC, FTCA, CDPH, payer audits, etc). * Participate in cross-functional meetings as needed. * Additional duties as assigned. Supervisory Responsibilities: * n/a Qualifications Education * Bachelor's degree education in health-care administration, health information management or law is required. * Master's degree level in related field is preferred. * Relevant professional certifications a plus. Experience * Minimum 2-4 years of experience in health-care compliance, coding/billing auditing, documentation review, or quality improvement. * FQHC, ambulatory care setting, or multisite clinic environment strongly preferred. * Working knowledge of Medi-Cal, CMS, HRSA, FTCA, and CA-specific health-care regulations. Certifications (Preferred) * Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) * Certified in Healthcare Compliance (CHC), or equivalent * Dental coding certification a plus * QI, risk management, or safety certification is a plus Required Skills and Abilities * Strong understanding of HIPAA, HITECH, 42 CFR Part 2, CMS Billing Guidelines, Medi-Cal requirements, Cal/OSHA, and TJC standards. * Coding knowledge (ICD-10, CPT, HCPCS, CDT, DSM-5). * Excellent analytical, critical thinking, communication, and report-writing skills. * Ability to manage multiple audits simultaneously. * Ability to maintain confidentiality and professionalism at all times. * Proficiency using EHRs (Epic, eCW, Dentrix, etc.), audit tools, spreadsheets, and dashboards. Physical Requirements and Working Conditions * Fulfill Immunization and fit for duty regulatory requirements. * Office and clinic-based; travel required between sites. * Occasional evening / morning hours for audits or meetings. * Ability to sit, stand, and walk for extended periods. * Ability to lift up to 20 lbs. Benefits: Our benefits program is designed to protect your health, family and way of life. We offer a competitive Benefits Program that includes affordable health insurance and Health Reimbursement Accounts (HRA), Dental and Vision Insurance, Educational and Continuing Education Benefits, Student Loan Repayment and Loan Forgiveness, Retirement Plan, Group Life and AD&D Insurance, Short term and Long Term Disability benefits, Professional Fee Reimbursement, Mileage and Cell Phone Reimbursement, Scrubs Reimbursement, Loupes Reimbursement, Employee Assistance Programs, Paid Holidays, Personal Days of Celebration, Paid time off, and Extended Illness Benefits. Marin Community Clinics is an Equal Employment Opportunity Employer. Min USD $84,200.00/Yr. Max USD $95,000.00/Yr.

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

The range for this role is $116,000 - $167,500 Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and able to work onsite full time in our Melbourne, FL office. The Mission At Christian Care Ministry we believe that Christians can, and should, share in one another's burdens. Through the use of Medi-Share , a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility. The Team Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren't perfect people, we are serving our perfect God and our Members to the best of our ability. The Job The Principal Internal Auditor reports to the Chairman of the Audit Committee (administratively to the Chief Risk Officer) and is responsible for the timely execution of risk-based internal audits in accordance with the annual internal audit plan, as well as assisting with other audit matters and projects, as directed by the Audit/Finance Committee. Coordinates, controls, develops, and administers Christian Care Ministry's internal audit program, system and procedures to determine the effectiveness of controls, accuracy of records, and efficiency of operations. Reviews company operations and financial systems and evaluates their efficiency, effectiveness, and compliance with internal corporate policies and procedures, and applicable external laws and government regulations. Essential Job Duties & Responsibilities Conduct risk assessments of ministry operations and departments Establish risk-based internal audit plan and work programs Determine scope of audits in consultation with Audit Committee Review and assess the suitability of internal control design Conduct audit testing of specified areas and identify reportable issues and dimensions of risk Perform inquiries and testing as needed to identify and resolve vulnerabilities Develop audit programs to ensure adequate financial controls Evaluate compliance with ministry policies and procedures Communicate audit findings to Senior Management and Audit Committee Prepare comprehensive audit reports for review with Senior Management and Audit Committee Contribute to the exercise and expression of CCM's Christian beliefs All other duties as assigned Essential Skills & Abilities Outstanding written/verbal communication skills and interpersonal/relationship building skills Strong data analytics experience and top-notch investigatory and research skills Extensive knowledge and familiarity with IT systems, tools, and IT general controls Thorough knowledge and understanding of AI (artificial intelligence) concepts and tools Advanced MS Excel/Word/PowerPoint skills Ability to adapt to change quickly and multi-task effectively Ability to read and interpret documents; author routine reports and correspondence; and speak effectively with members, providers, and/or associates of the organization Core Competencies/Demonstrable Behaviors Manages complexity - making sense of complex, high quantity and sometimes contradictory information to effectively solve problems Financial acumen - interpreting and applying understanding of key financial indicators to make better business decisions Drives Results - consistently achieves results, even under tough circumstances/ tight deadlines. Resourcefulness - securing and deploying resources effectively and efficiently Optimizes work processes - knowing the most effective and efficient processes to get things done, with a focus on continuous improvement Education and/or Experience Bachelor's degree in accounting or finance with 7-10 years' financial experience, through public accounting or industry that includes 5 years' external or internal auditing required Certified Public Accountant certification preferred Certified Internal Auditor certification preferred Supervisory Responsibilities This job has supervisory responsibilities: you will be expected to supervise a team of 1-2 employees Incentives & Benefits We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others. For full-time employees working 30 hours or more, some of our benefits include, but are not limited to: • 100% paid Medical for employees/99% for family • Generous employer Health Savings Account (HSA) contributions • Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance • 6 weeks of paid parental leave (for both mom and dad) • Dental - two plans to choose from • Vision • Short-term Disability • Accident, Critical Illness, Hospital Indemnity • 401(k) - up to 4% match on ROTH or Traditional contributions • Generous paid-time off and 11 paid holidays • Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo • Employee Assistance Program including no cost, in-person mental health visits and employee discounts • Monetary Anniversary Awards Program • Monetary Birthday Awards Minimum Age Requirement: Due to the nature of the responsibilities associated with this position-including independent decision-making, access to confidential information, and potential exposure to regulated environments-candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

- MUST be in the office located in Chappaqua, NY 3 days a week. Are you a seasoned compliance professional with a passion for anesthesia and healthcare auditing? Do you thrive in fast-paced environments where your expertise can make a real impact? FlexStaff is seeking a dynamic, detail-oriented Lead Compliance Auditor to join our client's team and lead the charge in safeguarding healthcare integrity and regulatory excellence! Position Summary: As a Lead Compliance Auditor, you will leverage your extensive anesthesia auditing experience to oversee comprehensive compliance reviews, develop training programs, and collaborate with senior leadership to enhance our compliance framework. Your expertise will ensure the organization remains at the forefront of regulatory adherence, risk mitigation, and quality improvement. Ready to make a difference in healthcare compliance with your anesthesia expertise? Don't miss this chance to elevate your career! Responsibilities: Lead complex anesthesia-specific compliance audits, including CPT, ICD-10, modifiers, and billing practices. Develop and deliver targeted training for clinical staff on anesthesia coding, documentation, and regulatory requirements. Identify risk areas through detailed data analysis, trend monitoring, and audit findings. Collaborate with leadership to refine audit strategies and implement process improvements. Prepare detailed reports, presentations, and corrective action plans to ensure ongoing compliance excellence. Support ongoing education initiatives to elevate staff awareness and adherence to federal, state, and industry regulations. Qualifications: Minimum of 10+ years of healthcare compliance auditing experience with a heavy focus on anesthesia. Deep knowledge of anesthesia coding, billing, and documentation standards, including CPT, ICD-10, HCPCS, and modifier usage. Proven success in leading complex audits, developing training materials, and mentoring teams. Strong analytical skills with the ability to interpret data and identify trends. Exceptional communication skills for engaging with senior leadership and clinical staff. Experience working with regulatory bodies and understanding of HIPAA, Medicare, Medicaid, and third-party payers. Experience leading impactful compliance initiatives in a reputable healthcare organization. Expertise in Collaborating with team members dedicated to excellence for continuous improvement. Shape compliance strategies and influence organizational policies. *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts,

What You'll Do As a part of the Regulatory Compliance Division, under the direction of the Director of Regulatory Compliance and the Audit & Financial Investigations Manager: * Lead and supervise the activities of the audit function of the Ohio Casino Control Commission, ensuring efficient and effective execution of audits across casino gaming, sports gaming (sports betting), fantasy contests, and skill games, ensuring compliance with the Ohio Revised Code and Ohio Administrative Code. * Supervise audit staff, including planning, scheduling, and overseeing projects and other tasks, monitoring performance, providing training, and conducting evaluations to maintain high standards of professional excellence. * Review audit projects to ensure identified objectives have been completed and documented appropriately in accordance with established auditing standards and division expectations. * Conduct risk assessments to determine the focus of the audit plan, developing audit procedures and designing projects in accordance with identified risks. * Provide feedback to staff for adjustments to audit work product. * Collaborates cross-functionally to share expertise and enhance processes with other teams and divisions. * Exhibits strong time management, communication, teamwork, and analytical skills to lead a team of audit professionals to achieve high-quality outcomes. * Represents the division at meetings, conferences, or other events. * Stays up-to-date on industry processes, regulations, and advancements. 6 yrs. exp. in auditing or accounting which must have included 3 yrs. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description; 2 yrs. exp. as audit team lead or auditor in charge. * Or completion of undergraduate core coursework in accounting, business administration; computer science or related field; 4 yrs. exp. in auditing or accounting which must have included 2 yrs. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description; 2 yrs. exp. as audit team lead or auditor in charge. * Or 12 mos. exp. as External Auditor 3, 66463. * Or equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: Auditing