Program Integrity Auditor: Health Plan Coding & Compliance
Sacbar
CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records for correct coding and documentation across Medicaid lines of business. The auditor will identify issues and recommend actions to educate providers and recover funds. Candidates need 3–5 years in claims data review and coding, plus active CPC/CCS/CPMA certification. This full-time role is based in alignment with Arizona time zones and duties as described. #J-18808-Ljbffr Sacbar
$46.99k - $122.4k
...building a world of health around every individual... ...Position Summary The Program Integrity Auditor is responsible for... ...to determine correct coding and appropriate documentation... ...member for a health plan(s) which currently... ...rules. Maintain compliance with company policies...Health InsuranceHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$88.85k
...Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created... ...purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for audits of... ...details are correct so that the project’s/program's deliverable meets the needs of the...Health Insurance- Description Revenue Cycle Auditor Position Overview The... ..., ensuring accuracy in coding and billing information... ..., and set up payment plans for outstanding... ...Implement and adhere to compliance standards and regulations... ..., Medi-Cal, Commercial Health Plans) Thorough understanding...Health InsuranceFlexible hours
- ...Internal Audit Consultant will support audit, compliance, fraud detection, and investigative... ..., confidentiality, and evidence integrity Qualifications Requires a bachelor’s degree... ...collaboratively in a team environment Experience in health care, health insurance, financial...Health InsuranceFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
$102k - $115k
...Description Astrana Health is seeking Manager... ...data & documentation integrity, and supporting vendor programs. This manager will... ...all diagnosed codes and conditions are... ...risk adjustment and compliance. Serve as the vendor... ...payers and health plan partners with continuous...Health InsuranceWork at officeRemote work$125.4k - $179.3k
...chronic disease treatment plans. Identify patient health‑care needs and develop comprehensive... .... Participate with the Integrated Care Sales team in events... ...in the on‑call program available to members after... ...Knowledge of HCC and ICD‑10 coding and documentation. Knowledge...Health InsuranceFor contractorsWeekend work- Northrop Grumman is seeking a seasoned auditor to travel to various program locations, performing audits of program management activities and Earned Value Management (EVM) implementations. You will verify financial EAC updates, reserves, and supplier performance against...
$90.86k - $136.29k
Your Role The Medicare Compliance team is responsible... ...Advantage and Part D plan operations to help ensure... .... The Government Programs Compliance Specialist,... ...accuracy, completeness and integrity of plan materials,... ...and the Department of Health Care Services (DHCS)....Health InsuranceFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week- ...Guiding teams in the strategic planning and execution of audit and... ...stakeholders to identify and address compliance challenges Developing and... ...audit teams Validating data integrity, security, and compliance... ...Mathematics/Quantitative Finance, Health Administration/Public Health,...
- ...Memorial Hospital Presbyterian is seeking a Population Health Program Manager to lead CMS, HEDIS, and health plan initiatives within Hoag Clinic. You will guide... ...Hoag Clinic and Enterprise IT, Cybersecurity, Compliance, and Marketing to improve care quality and patient...Health Insurance
- ...solutions. This unique opportunity requires reviewing AI-generated translations of US tax statutes to ensure accuracy, legal integrity, and technical compliance. Your expertise will help shape the future of advanced tax technologies. Key Responsibilities Read and interpret...For contractorsRemote work
- ...our competitive Total Rewards package, which includes wellness programs designed to support our team members' financial, physical, and... ...two years Audit or related experience Assist in maintaining compliance with the internal Control System Perform other projects and duties...Health InsuranceLocal areaNight shift
$200k - $235k
...it, they are in a health insurance system that... ...health sharing program that is much more... ...Member Services, Compliance, Operations, and executive... ...tool) and oversee integration with the case... ..., training plans, quality review processes... ..., disputed SMBs, coding-related clinical questions...Health InsuranceFull time$71.7k - $105k
myPlace Health is built around a simple but... ...communities. As a PACE (Program of All Inclusive... ...Documentation Integrity (CDI) Specialist supports... ...concerns, compliance risks, and systemic... ...knowledge of ICD‑10‑CM coding principles and... ...Retirement Saving Plan with employer...Health Insurance$25.97 - $31.57 per hour
Deputy Auditor Markleeville, CA | Alpine County Department of Finance... ...annual increases thereafter. Health Insurance: County provides... ...Retirement System (PERS), 2% at 62 plan for New Members. Deferred... ...Voluntary deferred compensation program offered. Housing Assistance:...Health InsuranceFull timeWork at officeLocal area$106.4k - $133k
...Developer Security Platform integrates seamlessly into development... ...prevent vulnerabilities — from code and dependencies to... ...factors. Our Total Rewards program includes, but is not limited to 401(k) retirement plan, paid time off, health, dental, and vision insurance...Health InsuranceWork at officeWork from homeFlexible hours- Jobtailor is seeking a BSA/AML audit professional to develop, audit, and monitor compliance across financial institutions of all sizes. You will execute all audit phases, present findings to senior management, and build relationships across three lines of defense. A Bachelor...
- Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to join the Quality - Risk Adjustment team in Orange, CA. The role requires expertise in Medicare Advantage, ACA, and commercial risk adjustment coding, with significant travel to provider sites to...
$150k - $170k
...government aerospace programs across North... ...Excellence operating as an integrated platform with 150+... .... Partner with Planning, Engineering,... ...throughput. Ensure compliance with AS9100... ...plan HSA‑eligible health plan with employer... ...Angeles Municipal Code and applicable federal...Health InsuranceFull timeWork at officeLocal areaShift work$100k - $115k
...management, and industry compliance to drive success... ...leasing and marketing plans, resident relations, budget... ...resident retention programs. Supervises building... ...disability programs Mental health resources, such as... ...the right thing with integrity. Welcoming and inclusive...Health InsuranceWork at office$130k - $150k
...seasoned Senior Oracle Payroll Integrations Developer to design, build,... ...while ensuring data accuracy, compliance, and performance. The ideal... ...excels at writing clean, scalable code for complex transformations... ...off Medical insurance Dental plan Vision plan Life insurance...Health InsuranceTemporary workRemote work$75k - $90k
...Housing and Disability Advocacy Program (HDAP) Legal Aid Society of... ...work disciplines. Benefits Health care coverage Life insurance... ...holidays 401(k) retirement plan Minimum Qualifications Active... ...records and support grant compliance and reporting requirements Support...Health InsuranceFull timeWork at officeLocal areaImmediate startRemote workFlexible hoursAfternoon shift- ...cloud and infrastructure teams to identify compliance gaps Conduct gap analyses and readiness... ...in cross-functional projects integrating FedRAMP High and DoD IL4/IL5 requirements... ...compliance, or risk management, with federal program exposure 5+ years of hands-on FedRAMP...
$140k - $180k
...a global capital program management and advisory... ..., we help clients plan, execute, and... ...capital programs. Our integrated services span... ...projects, costs, and compliance. Our engineering... ...other generative coding tools are part of... ...You Comprehensive health coverage (medical,...Health InsuranceImmediate startRemote workWorldwide- Verify Incorporated is seeking a QMS Auditor specializing in AS9100 certification to ensure the effectiveness of our Quality Management System (QMS). You will perform audits, identify findings, and report directly to clients using a web application. The ideal candidate...
- ImmunityBio, Inc. is seeking a Senior GCP Auditor to ensure GCP compliance across its trial operations. The role collaborates with Clinical Operations, Regulatory, Pharmacovigilance, Medical Writing, and Data Management to maintain readiness and uphold quality standards...Remote job
$150k - $278k
...the Senior Manager, Program Management role at... ...Management Job Code: 32263 Job Location... ...to the program’s integrated product teams (... ...to ensure program compliance and to enable program... ...operational plans that have measurable... ...benefits, including health and disability insurance...Health InsuranceFull timeContract workLocal areaFlexible hours$243.2k - $304k
...their first line of code through production,... ...vulnerabilities and compliance drift during the generation... ...100% paid employee health, dental, and vision plans (choose HMO, PPO, or... ...Employee Assistance Program (EAP) 11+ Observed... ..., our Candidate Integrity Policy prohibits the...Health InsuranceTemporary workWork at officeLocal areaRemote workFlexible hours- ...responsible for the design, planning and development of... ...III will follow coding standards throughout all... ...quality. Analyze and integrate new technologies with... ...Maintain proficient programming skills in REST web services... ...Flexible Spending Account - Health Care/Childcare...Health InsuranceTemporary workFlexible hours
$159.2k - $191.05k
...BILL’s risk operations and protect the integrity of its payment platform. In this... ...disability insurance, 401(k) retirement plan, flexible spending & health savings account, paid holidays, paid... ...coverage Employee Assistance Program (EAP) 11+ Observed holidays and wellness...Health InsuranceTemporary workWork at officeRemote workFlexible hours
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