NewRN, DRG Coder / Clinical Auditor Pivotal Placement ServicesRN, DRG Coder / Clinical AuditorBaton Rouge, LA$90,000–$104,841 / yearHeadquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionals—from staff to leadership—with both clinical and non-clinical employers. Our comprehensive and customer-focused workforce solutions include Direct Placement and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.
NewCharge Auditor Clinical - Surgical Services CHRISTUS HealthCharge Auditor Clinical - Surgical ServicesSanta Fe, NMThe Charge Auditor Clinical is a Registered Nurse who performs the primary functions of coordinating the process of capturing observation charges and other direct care/nursing department charges. Develops and implement plans for both formal and informal education of nursing and other clinical associates regarding documentation and related observation charging and billing.
NewInternal Auditor I Herc Rentals IncInternal Auditor IBonita Springs, FL$65,000–$75,000 / yearPlease be advised that the actual salary offered for any position is subject to the company's sole discretion and may be influenced by various factors, including but not limited to the candidate's qualifications, experience, location, and overall fit for the role. Founded in 1965, Herc Rentals is one of the leading equipment rental suppliers in North America with 2025 total revenues reaching approximately $4.4 billion.
NewCompliance Auditor II - Compliance CHRISTUS HealthCompliance Auditor II - ComplianceIrving, TXProvides feedback to HIM, Case Management, Patient Financial Services (PFS), Revenue Cycle, physicians and Hospital and Clinic operations regarding charging, documentation, patient status and coding issues so 'process improvement' changes are made. Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect CHRISTUS and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact.
Clinical Reimbursement Manager - RN Vi LivingClinical Reimbursement Manager - RNHilton Head Island, SC$82,487.45–$107,228.73Coordinates with rehabilitation services Program Director, Corporate Director of Clinical Reimbursement and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end. The CRM also manages the overall process and tracking of all Medicare/Managed Care case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center.
NewDRG Coder, Registered Nurse Pivotal Placement ServicesDRG Coder, Registered NurseWashington, DC$90,000–$104,841 / yearHeadquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in healthcare talent—from frontline staff to executive leadership—in both clinical and non-clinical roles. We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records.
Revenue Cycle Auditor RN - Full time, Day, Remote Providence St. Joseph HealthRevenue Cycle Auditor RN - Full time, Day, RemoteRenton, WARemoteFull timeProvidence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Registered Nurse (RN) Revenue Cycle Nurse Auditor (FT M-F 8-5) UMC Health SystemRegistered Nurse (RN) Revenue Cycle Nurse Auditor (FT M-F 8-5)OKEducation and Experience • Bachelor's degree in nursing from an accredited college or university • 5+ years of experience in utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B, & C billing requirements • Advanced experience with national evidence-based screening guidelines (MCG, formerly Milliman Care Guidelines) • Viseo software experienced user, is preferred Required Licensures/Certifications/Registrations • Valid Texas RN License/Eligible Compact License Knowledge, Skills and Abilities • Well-versed in ICD10 diagnosis codes and payer regulations • Expert level analytical and process mapping skills • High level knowledge of Medicare, managed care, and commercial insurance payment requirements • Excellent attention to detail, communication and reporting skills • Highly organized with the ability to multi-task and prioritize work • Self-starter with the ability to think outside-the-box to solve problems • Customer service focus, critical thinker, and excellent interpersonal skills Interaction with Other Departments and Other Relationships Collaborate with colleagues in patient financial services, practice management, and other relevant departments. Benefits: Resilience program Emotional Physical Spiritual Financial Career Community On-Site Professional Counselors (EAP) Discounted Pharmacy Cost Cash Retention Bonus (only one in our region) Retirement Benefits w/Employer Match PTO & Extended Illness Medical, Dental, & Vision Insurance And more at: https://apps.umchealthsystem.com/documents/wellness.pdf
Nurse Auditor Houston Methodist HospitalNurse AuditorHouston, TXThis position will complete audits to ensure that the clinical documentation contained within the patient chart supports items and services included on the patient bill and identifies and corrects errors or discrepancies to accurately support reasons for treatment, billing, payment or operations. We are committed to providing quality, cost-effective health care in a compassionate environment for a full range of services, including emergency care, cardiology, orthopedics and sports medicine, comprehensive women's services, neurology and neurosurgery, oncology, and primary and general medicine.
Nurse Auditor/Revenue Integrity (FLEXI) Chesapeake Regional HealthcareNurse Auditor/Revenue Integrity (FLEXI)Chesapeake, VirginiaSenior Level Coding experience of at least 20 years or 10 years in a coding management level recent experience coding in an acute hospital setting required, with coding ability demonstrated via a skills assessment or a RN with 20 years of experience as an intensive care unit, emergency department or documentation specialist nurse auditor or an LPN with a combined coding and auditing background. Work and review a high volume of accounts assigned to Revenue Integrity Nurse Auditor work queues for charge review of all observation account documentation to charges, carve-out observation time from procedures, review documentation to charge code injection and infusion charges and the review of ED documentation to assign and charge code appropriate visit levels to ED visits.
Remote Clinical Nurse Auditor CGI IncRemote Clinical Nurse AuditorKnoxville, TNRemote$52,200–$114,900 / yearHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information. Your future duties and responsibilities: Conduct Claim Audits: Perform inpatient and outpatient audits to determine medical necessity, validate prior authorizations, conduct clinical validations, or execute medical service charge audits to recover improper payments.
DRG Nurse Auditor University Health Services IncDRG Nurse AuditorRICHMOND, VAResponsibilities Atlantic Region CBO: The Atlantic Region Central Billing Office ("ARCBO") or ("CBO") provides business office services including billing, collections, cash posting, pre-access management, variance, and customer service to our affiliated Universal Health Services hospitals. The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case management experience to be responsible for analyzing clinical claim denials, drafting detailed appeal letters, evaluating clinical level of care, and the review of denial trends.
RN Surgical Charge Auditor, Medical Plaza I, 6a-2:30p University of Louisville Physicians IncRN Surgical Charge Auditor, Medical Plaza I, 6a-2:30pLouisville, KYJob Description Summary: UofL Health is a not-for-profit 501(c)(3) fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, more than 250 physician practice locations, and more than 1,200 providers in Louisville and the surrounding counties, including southern Indiana. With more than 14,000 team members - physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.
Nurse Auditor - Medical Bill Review (Remote) Rising Medical SolutionsNurse Auditor - Medical Bill Review (Remote)Chicago, ILRemoteJoin our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
High-Cost Claimant Review Unit Nurse Auditor (Remote in AZ) Blue Cross Blue Shield of ArizonaHigh-Cost Claimant Review Unit Nurse Auditor (Remote in AZ)Phoenix, ArizonaRemotePrimary responsibilities include: Function as a designated clinical resource to review High Cost Claimants to identify opportunities to improve member outcomes and determine correct utilization of resources. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Nurse Auditor, Revenue Integrity - (Remote) Trinity HealthNurse Auditor, Revenue Integrity - (Remote)Livonia, MIRemote$31.88–$47.82 / hourNS IV - licensed: Licensed role (direct or indirect healthcare); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment within scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to perform activities with general oversight, through personal contributions, teamwork & initiatives to safely improve outcomes; Advocates for patients & informs / counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or lead / coordinate / supervise direct & essential care activities or role-based service responsibilities of unlicensed / licensed / certified healthcare professionals within licensed scope of practice. Work Focus: Performs clinical care activities (direct or indirect) for patients within the "scope of practice" laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & flow of the care experience.
Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX IMCS Group IncTemp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TXDallas, TXProvides detailed reports and develops corrective action plans to correct discrepancies identified during theaudit process. Detail-oriented with strong organizational and time management skills and the ability to effectively prioritize daily tasks.
NewMedical Review Nurse - Home Health Auditor MachinifyMedical Review Nurse - Home Health AuditorAs a MR Nurse Auditor, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
High-Cost Claimant Review Unit Nurse Auditor Blue Cross and Blue Shield AssociationHigh-Cost Claimant Review Unit Nurse AuditorPhoenix, AZPrimary responsibilities include: Function as a designated clinical resource to review High Cost Claimants to identify opportunities to improve member outcomes and determine correct utilization of resources. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Charge Auditor Registered Nurse Per Diem Advocate Aurora Health IncCharge Auditor Registered Nurse Per DiemLibertyville, IL$38.20–$57.30 / hourProviding care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise.
RN Surgical Charge Auditor, Medical Plaza I, 6a-2:30p UofL HealthRN Surgical Charge Auditor, Medical Plaza I, 6a-2:30pLouisville, KentuckyUofL Health is a not-for-profit 501(c)(3) fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, more than 250 physician practice locations, and more than 1,200 providers in Louisville and the surrounding counties, including southern Indiana. With more than 14,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.
NewHEDIS AUDITOR RN/ LPN Integrated Resources, IncHEDIS AUDITOR RN/ LPNNewark, New JerseyFull timeHedis Auditor Rn/LpnIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. Job DescriptionThis request is for the 2018 HEDIS audit, Position is responsible for performing medical record reviews and data extraction for the HEDIS audit.
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska Molina Healthcare IncAuditor, Healthcare Services (RN) (Remote) Must Live In NebraskaLincoln, NERemotePerforms audits in care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. At least 2 years health care experience, with at least 1 year experience in care management, and/or managed care, or equivalent combination of relevant education and experience.
Inpatient Hospital Auditor - RN Judge GroupInpatient Hospital Auditor - RNRemote$39–$40 / yearBy providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. This role conducts desk audits, develops audit tools, identifies institutional trends, and designs audit protocols and special projects.
Revenue Cycle Auditor RN -Remote Providence Health & ServicesRevenue Cycle Auditor RN -RemoteOregon, ORRemoteRequsition ID: 428089 Company: Providence Jobs Job Category: Revenue Cycle Operations Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4001 SS RC REV INTEGRITY Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Revenue Cycle Auditor RN - Full time, Day, Remote Providence Health & ServicesRevenue Cycle Auditor RN - Full time, Day, RemoteCARemoteRequsition ID: 437237 Company: Providence Jobs Job Category: Revenue Cycle Operations Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4001 SS RC REV INTEGRITY Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: On-site Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
CDI Auditor-Registered Nurse Full Time-Days Riverside HospitalCDI Auditor-Registered Nurse Full Time-DaysNewport News, VirginiaThe Clinical Documentation Improvement (CDI) Auditor will facilitate improvement system-wide in the overall quality, completeness, and accuracy of the medical record documentation through extensive audit investigation, education and data analysis. Certified Clinical Document Specialist (CD) - Association of Clinical Documentation Integrity Specialists (ACDIS) or CDIP Certified Documentation Integrity Professional (Required) and.
DRG/Clinical Validation Auditor RN UnitedHealth Group IncDRG/Clinical Validation Auditor RNPlymouth, MN$35–$62.50 / hourThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance.
Medical Review Nurse - CMS/RAC Auditor, Government Audits MachinifyMedical Review Nurse - CMS/RAC Auditor, Government AuditsDeployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
Medical Review Nurse - SNF/MDS Auditor MachinifyMedical Review Nurse - SNF/MDS AuditorMust be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
RN Nurse Auditor-Patient Financial Services Eisenhower Medical CenterRN Nurse Auditor-Patient Financial ServicesRancho Mirage, CA$48.09–$78.18 / hourJob Objective: Responsible for concurrent audits of Medical Record Chart for verification of consistent demographic data and completeness of clinical documentation Responsible for pre-auditing medical records for all accounts scheduled for audits by insurance companies, external audit agencies and/or patient requested audits. Coordinates medical record audit scheduling with external auditors, medical records and ancillary departments when necessary Meets with external auditors during schedule audits and assists as needed Conducts exit conference with external auditors.
(RN) Registered Nurse Coding Auditor - HCS-D, COS-C - Full Time Northwell Health Inc(RN) Registered Nurse Coding Auditor - HCS-D, COS-C - Full TimeGarden City, NYRemoteWhen determining a team members 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, budget and internal equity). Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.
Clinical Auditor I-Nurse WellSense Health PlanClinical Auditor I-NurseRemoteRemoteFull timeThe Clinical Auditor I performs detailed medical record audit review and analysis of the health plan’s outpatient, professional and ancillary claims to ensure that all reimbursement to the provider is paid accurately and ensuring adherence to regulations, internal policies and best practice of patient care. · Proactively identify potential fraud and abuse by scrutinizing clinical data, documenting billing errors, and highlighting opportunities to manage benefit costs and secure savings.
Delegation Oversight Clinical Auditor RN II L.A. Care Health PlanDelegation Oversight Clinical Auditor RN IILos Angeles, CAThis position assist in maintaining continuous quality improvement in the Delegation Oversight Clinical Audit unit ensuring that departmental/divisional and organizational goals are accomplished through overseeing and facilitating compliance of the Plan Partners, Participating Provider Groups (PPG), Specialty Health Plans (SHP), and contracted provider network as managed by the Delegation Oversight Department. The position also acts as a liaison between the Plan Partners, PPGs and Vendors regarding Utilization Management (UM) issues; assists in improving access and utilization performance of PPGs by being a resource for best practice and providing continuous performance feedback.
DRG Auditor MMC GroupDRG AuditorSan Antonio, TXDRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients.
Remote MSDRG Auditor CGI IncRemote MSDRG AuditorCharlotte, NCRemote$58,000–$114,900 / yearThe DRG Validation Auditor is charged with rendering appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Position Description: The DRG Validation Auditor is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans, including Commercial and Government Clients.
Senior Internal Auditor Cincinnati Children’s HospitalSenior Internal AuditorWorking with Cincinnati Children’s management to plan and execute a comprehensive, risk-based audit plan encompassing financial, operational, and compliance activities in order to provide insight into key processes, support informed decision-making, and promote consistency with organizational policies, regulatory expectations, and industry-leading practices. As part of our Internal Audit team, you will work across a wide range of functions and collaborate with leaders throughout the organization—gaining valuable perspective while contributing to meaningful work that directly supports our mission.
Coding Quality Auditor and Specialist, HB Coding, Full-time, Days (Remote - Must reside in IL, IN, IA, WI, OH, MO, MI, or FL) Northwestern Memorial HealthCareCoding Quality Auditor and Specialist, HB Coding, Full-time, Days (Remote - Must reside in IL, IN, IA, WI, OH, MO, MI, or FL)Chicago, ILRemoteThe Coding Quality Auditor and Specialist is responsible for maintaining quality work queues and quality reports, advanced and complex project work that includes, but is not limited to, Risk Adjustment, Mortality Review, Hospital Acquired Condition (HAC) and Patient Safety Indicator (PSI) Review, Quality Abstraction and Analysis, and/or special and non-traditional project work. Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and assists the Managers of Clinical Documentation and Coding in implementing key strategies to effect change.
NewAuditor, Quality Medical Talent Software Services, Inc.Auditor, Quality MedicalColumbia, SC$36 / hourRequired Training: Registered Records Administrator or Technician, OR active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Certified Coding Specialist. Create monthly/quarterly reports to present to each line of business, providing information on records review, outcomes, trends, and savings impacting medical costs and contracting rates.
Clinical Denials Auditor Huron Consulting Group IncClinical Denials AuditorChicago, IL$80,000–$105,000 / yearThe Utilization and Denials Management Auditor is responsible for the day-to-day production and quality functions of a team of Utilization and Denials Management specialists specializing in meeting client production goals and accuracy goals. The Auditor assists Utilization and Denials management in preparing daily operational reports, provide QA (quality assurance) feedback, and participate in the client interactions and internal stakeholder meetings.
Clinical Documentation Consultant (CDI) DRG Validation / Auditor Pyramid, IncClinical Documentation Consultant (CDI) DRG Validation / AuditorOakland, CA$45–$50 / hourFull timeBy applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. ICU, Critical Care, Emergency Department, Hospitalist, Case Management, Utilization Review, or CDI experience.
Clinical Review Auditor I CorVel Healthcare CorporationClinical Review Auditor IFort Worth, TXRemote$70,143–$107,253 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.
Medical Compliance Auditor Texas Children's HospitalMedical Compliance AuditorBellaire, TXThis process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers.
Clinical DRG Validation Auditor Judge GroupClinical DRG Validation AuditorRemote$30–$36 / yearThis role develops audit forms, identifies trends, designs audit protocols, and completes DRG validation, per‑diem reviews, bill verification, and credit balance audits. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.
Clinical Documentation Consultant (CDI) DRG Validation / Auditor Pyramid Consulting, IncClinical Documentation Consultant (CDI) DRG Validation / AuditorOakland, CARemote$45–$50 / hourBy applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. ICU, Critical Care, Emergency Department, Hospitalist, Case Management, Utilization Review, or CDI experience.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance Health IncDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)NV$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Outpatient Facility Auditor UnitedHealth Group IncOutpatient Facility AuditorDallas, TX$28.94–$51.63 / hourThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Requisition number: 2353481 Job category: Claims Primary location: Dallas, TX Additional locations: Phoenix, Arizona | Hartford, Connecticut | Tampa, Florida | Minneapolis, Minnesota Date posted: 04/21/2026 Overtime status: Non-exempt Travel: No.
Patient Safety DRG Clinical Validation Auditor Elevance Health IncPatient Safety DRG Clinical Validation AuditorIndianapolis, IN$86,560–$129,840 / yearPreferred skills, qualifications and experiences: One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Compliance Auditor - Inpatient Focus Licking Memorial Health SystemsCompliance Auditor - Inpatient FocusNewark, OHPrimary focus on the compliance of home care, patient level of care, and patient status but also responsible for internal auditing of processes and practices to help assure consistency with federal and state law to include but not limited to compliance with the: Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Ohio Department of Health (ODH), Ohio Department of Medicaid (ODM), and Recovery Audit Contractors (RAC). Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.