- Centene Corporation (Sacramento, CA)
- …to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims audits ... a monthly, quarterly and annual basis to ensure regulatory compliance . + Perform claims compliance audits for...managed care programs and process claim audit observations. + Review and analyze responses to claims audit observations and… more
- Live Nation (Beverly Hills, CA)
- …management throughout the organization, as well as interactions with external auditors. The IT Auditor may direct and review the work performed by other internal ... part of the total internal audit plan. The IT Auditor will assist in the development of internal audit...SOX 404 effort, SSAE 18 SOC 1, SOC2, PCI compliance , Data Privacy and Protection, functional and operating units,… more
- UCLA Health (Los Angeles, CA)
- … will be responsible for the daily audit of all examiners assigned to the auditor . You will review claims (paid, pending, and denied) for accuracy, appropriate ... services, contract interpretation, Division of Financial Responsibility (DOFR), and application/ compliance with policies and procedures. You will: + Research over… more
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... auditing of claims, educating Prime's network pharmacies and driving contract compliance , and supporting downstream claim corrections to eliminate potential waste.… more
- Datavant (Sacramento, CA)
- …We are seeking a highly motivated and experienced Internal Controls Sr. Auditor to support the implementation of robust internal controls in preparation for ... they meet SOX standards and are sustainable for long-term compliance . The role requires a dynamic individual who can...Remediation & Implementation 7. Partner with control owners to review , light test (sample of 1), and validate controls… more
- Sharp HealthCare (San Diego, CA)
- …to expedite and enhance net revenue collection. Also conducts regular quality review audits to ensure Revenue Cycle follows best practices guidelines established by ... to reconcile inventory or identify opportunities for increased revenue collection. Review and trend Denial/Underpayment Management Reports and work with internal… more
- Lincoln Financial (Sacramento, CA)
- …#:** 74448 **The Role at a Glance** We are seeking an enthusiastic Senior IT Auditor who is a self-starter and initiative driven, ready to take ownership of critical ... an internal audit environment, while focusing on an in-depth review of IT systems, cybersecurity and data integrity controls....risks, and control objectives. + Carry out duties in compliance with all state and federal regulations and guidelines.… more
- Sharp HealthCare (San Diego, CA)
- …+ 2 years' experience working as an HCC risk adjustment coding auditor . + Experience with medical billing, medical terminology, understanding of medical ... address issues identified through the audit/analysis.Identifies areas of potential compliance risk and notify management immediately.Identifies anomalies in coding.Identifies… more
- Robert Half Management Resources (San Francisco, CA)
- Description We are looking for an experienced Senior Internal Auditor to join our team on a long-term contract basis in San Francisco, California. This hybrid role ... background in public accounting, with a focus on methodology setup and review . Responsibilities: * Conduct detailed reviews to ensure the completeness and accuracy… more
- CVS Health (Sacramento, CA)
- …part in ensuring coding accuracy and data integrity, directly impacting compliance and financial performance. Ideal candidates will bring a strong understanding ... from home. **Position Summary** + Responsible for performing second level quality inter-rater review audits of medical records coded by internal team, as well as… more