• Risk Adjustment Clinical Auditor

    UPMC (Pittsburgh, PA)
    UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor /Analyst position in the Medicare department. This is a full time position ... Friday daylight hours and will be fully remote.. The Clinical Auditor /Analyst is an integral part of...outcomes, government audit outcomes, or ad hoc reviews. + Provide a clinical opinion for special projects… more
    UPMC (09/30/25)
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  • Clinical Revenue Auditor -CDM…

    Mount Sinai Health System (New York, NY)
    **Job Description** ** Clinical Revenue Auditor -CDM Patient Financial Services-Corporate-Full-Time-Days- Hybrid.** The Clinical Revenue Auditor for the ... financial health and compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position will report to the… more
    Mount Sinai Health System (09/24/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Atlanta, GA)
    **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... Shift:** Monday - Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** is responsible… more
    Elevance Health (10/22/25)
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  • Clinical Provider Auditor II…

    Elevance Health (MD)
    ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Location: Must be located in Maryland.** This field-based role enables ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying… more
    Elevance Health (10/04/25)
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  • RN Auditor , Clinical Services…

    Molina Healthcare (Bellevue, WA)
    The Clinical Services Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health ... Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-… more
    Molina Healthcare (10/18/25)
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  • Clinical Documentation Specialist…

    UNC Health Care (Chapel Hill, NC)
    …from entity to entity across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during ... we serve. Summary: This positon trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that are owned or… more
    UNC Health Care (10/28/25)
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  • Professional Medical Coding Educator…

    Catholic Health (Buffalo, NY)
    …consistent, accurate, and meets data integrity for use in billing, reimbursement, clinical outcomes, and for reporting. The Auditor /Educator will monitor ... with coding conventions, billing rules and Federal and State regulations. The Auditor /Educator will also provide timely education and feedback for Clinicians,… more
    Catholic Health (10/21/25)
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  • Profee Clinical Data Quality Admin (CDQA)…

    Virtua Health (Mount Laurel, NJ)
    …practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked ... Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other rules… more
    Virtua Health (10/28/25)
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  • Home Health Quality Assurance Auditor

    Humana (Corpus Christi, TX)
    …caring community and help us put health first** The Quality Assurance, Clinical Professional 1 consults and collaborates with clinicians to ensure high ... accountability of compliance and quality. The Quality Assurance, Clinical Professional 1 work assignments are often straightforward and of moderate complexity. The… more
    Humana (10/01/25)
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  • Sr Coding Compliance Auditor

    Catholic Health Initiatives (Chattanooga, TN)
    **Job Summary and Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an ... met at the highest level. The Sr Coding Compliance Auditor 's primary focus will be to facilitate and ensure...workload with the other portion of time focused on provider communication, and claims denial resolutions. Communicates denial trends… more
    Catholic Health Initiatives (10/04/25)
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