Lead external customer audits and utilization management oversight activities as a subject matter expert.
Analyze complex UM data, investigate findings, and prepare evidence-based responses for regulators and accreditation organizations.
Collaborate with operational, technical, and client-facing teams to drive compliance and process improvements.
This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.
Conduct clinical audits and risk assessments to identify compliance gaps.
Manage multiple client engagements and deliver accurate project results.
Build strong client relationships and present findings to leadership.
Kodiak Solutions transforms healthcare through technology-driven solutions, specializing in finance, unclaimed property, and risk management. Their innovative platform streamlines operations, allowing providers to focus on patient care.
Perform audits of enrollment, disenrollment, eligibility, and plan/PCP change transactions for health plan enrollment associates.
Review enrollment (834) file transactions and coordinate with state systems to confirm member effective dates and eligibility.
Collate, compile, and report QA performance to management and individuals, providing feedback for improvement.
HealthEdge provides AI-powered operational infrastructure for health insurance companies. UST HealthProof has a global workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Oversee CMS and state audit readiness, live audit management, and corrective action plans.
Build internal monitoring, training, and reporting to foster a culture of compliance.
Collaborate with clinical and operations teams to integrate audit findings into improvements.
Habitat Health empowers older adults to experience more good days through the Program of All-Inclusive Care for the Elderly (PACE), delivering coordinated medical and social care in homes and communities. Supported by leading healthcare organizations and investors, the company is expanding its scalable model with a mission-driven culture focused on participant well-being.
Audit participant electronic health records to ensure complete, accurate, and timely documentation.
Identify documentation gaps and collaborate with clinical teams to improve processes and regulatory readiness.
Reconcile regulatory logs and assist with audits and investigations to maintain data integrity.
WelbeHealth is a value-based healthcare organization that provides all-inclusive care to vulnerable seniors, keeping them in their communities. The company emphasizes a supportive team culture with work-life balance and comprehensive benefits.
Supports and strengthens the Compliance program by providing advisory support to business stakeholders.
Conducts compliance investigations and assists with auditing and monitoring activities.
Advances policy governance and development, translating regulations into practical guidance.
Rula is a mental health company dedicated to providing evidence-based, compassionate care to treat the whole person. They are a remote-first organization with a culture that values diversity, equity, and inclusion, hiring in most U.S. states.
Manage end-to-end IRB meeting workflows, including submissions, reviewer assignments, and meeting preparation.
Facilitate communication among client services, IRB Chairs, Board members, and clients to ensure timely review processes.
Prepare and review informed consent forms for regulatory compliance and quality.
The company coordinates Institutional Review Board (IRB) meetings within a highly regulated clinical research environment. They offer a collaborative and inclusive culture focused on ethical, patient-centered outcomes, though company size is not specified.
Conduct quality reviews and audit revenue cycle claims and workflows against established SOPs.
Develop, collect, and analyze quality improvement initiatives to support RCM operational functions.
Identify process deficiencies via analysis and trends, and deliver assessment results to leadership.
Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology.
Evaluate the effectiveness and integrity of insurance operations across a portfolio of specialty insurance partners.
Lead and participate in reviews covering underwriting, documentation, compliance, reporting, and financial activities.
Analyze findings, identify risks, and communicate actionable recommendations to mitigate issues.
Jobgether is a platform that uses AI-powered matching to connect candidates with job opportunities. The company fosters a collaborative, remote-friendly culture and partners with various employers to streamline the hiring process.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Lead the hospice compliance program, covering regulatory oversight, risk management, and audit governance.
Manage corrective action and policy lifecycles, ensuring compliance with Medicare CoPs and state regulations.
Coordinate external audit responses and internal investigations with leadership.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider that brings clinicians into patients' homes, offering continuum of care for those with chronic conditions. The company embodies a culture of compassionate service with its motto 'To Care is an Honor,' and seeks driven individuals to join their growing team.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Audit surgical and procedural coding for accuracy, documentation support, and compliance with ICD-10-CM, CPT, and HCPCS guidelines.
Document findings with authoritative guidance, assess financial impact, and recommend corrective actions.
Deliver facility-specific coding education and collaborate with health information management leadership and facility stakeholders.
A healthcare organization is seeking a Surgery Coding Auditor to ensure accurate surgical coding and compliance. The company operates across multiple healthcare facilities in the US and emphasizes quality assurance, education, and process improvement.
Conduct regulatory audits of COG institutions for compliance with NCI CTMB guidelines, IRB submissions, and informed consent documents.
Review protocol deviation forms and early closure requests, ensuring alignment with COG policies and federal regulations.
Serve as primary regulatory contact for sites, respond to complex inquiries, and develop SOPs and guidance documents.
COG Research Foundation, LLC is a California 501(c)(3) entity founded in 2024 to serve as a fiscal sponsor for the Children's Oncology Group (COG), providing legal, fiduciary, and administrative oversight for childhood cancer research. The organization unites over 13,500 experts at more than 220 leading hospitals and cancer centers worldwide, fostering a collaborative and mission-driven culture focused on improving outcomes for children with cancer.
End-to-end credentialing and payer enrollment for multi-state providers across commercial and Medicaid plans.
Vendor governance and SLA performance management to ensure timely provider onboarding.
Delegated credentialing and audit readiness, including NCQA and MCO compliance.
Blackbird Health provides virtual and in-person mental health services for children across Pennsylvania, Virginia, New Jersey, and Maryland, focusing on a whole-child approach that integrates brain, body, and behavior. The company is clinician-founded and owned, with a collaborative, supportive, and innovative team that is expanding into new markets in 2027.
Oversee and audit continuous identity and location verification across the remote employee lifecycle.
Manage compliance with Sentinel Vision monitoring, Yubikey tokens, and Webex admin console.
Lead incident response, exception management, and client notification for identity discrepancies.
Sutherland is a global digital transformation company specializing in AI, automation, cloud engineering, and advanced analytics. They work with iconic brands worldwide and have created over 200 unique inventions.
Conduct audits of medical records for compliance with federal coding regulations and guidelines.
Provide education and training to providers on CPT, ICD-10, and HCPCS codes.
Act as an internal expert to ensure coding compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company collaborating with medical groups, health plans, and health systems. It aims to optimize physician practices and improve patient experiences through cloud-based technology and scalable operations.
Support multiple regulatory exams and external audits for licensed jurisdictions, providing a standardized framework and preparing data requests.
Understand applicable regulations to ensure audits are designed to identify control gaps and non-compliance with laws.
Assist in driving compliance initiatives to completion and preparing status reports for management updates.
Binance is a leading global blockchain ecosystem behind the world’s largest cryptocurrency exchange by trading volume and registered users. With a presence in 100+ countries and trusted by 300+ million people, we offer a flat, user-centric structure that values autonomy and innovation.
Monitor coding prevalence and ensure compliance with CMS audit processes.
Conduct provider and coder level reviews to ensure accurate risk adjustment data submission.
Maintain tracking tools and assist in RADV audits and corrective action plans.
Alignment Health is a healthcare organization dedicated to transforming senior care, focusing on the chronically ill and frail. The company is fast-growing with a passionate team united in the mission to put seniors first.