Job Closed

This listing is no longer active.

EXL logo
EXL

We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay

High Cost Drug Auditor III

AuditorAuditorOtherRemoteSeniorTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

98 days ago

Salary

$60K - $90K / year

Seniority

Senior

Associate Degree3 yrs expExperience acceptedEnglish

Job Description

High Cost Drug Auditor III

EXL

• Apply your expert knowledge of billing HCD claims to perform extensive audit reviews. • Utilize HCPCS codes, medical record review, industry and EXL proprietary tools in the audit process. • Write professional communications documenting audit findings and supporting rationales. • Apply your extensive industry knowledge to identify audit trends and opportunities. • Conduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on high cost drug professional and outpatient facility claims. • Apply complex medical record reviews to identify discrepancies between physician orders, nursing administration logs, and final claims submissions. • Apply Medicare, Medicaid, and commercial guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. • Document audit results in a clear, concise, and effective manner using AMA Guidelines. • Utilize proprietary workflow systems to make audit determinations, generate audit rationales, and move claims through workflow process correctly efficiently and accurately. • Accurately reprice complex claims utilizing multiple client claims systems. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Research prescribed drug dosage and related conditions to ensure appropriateness of medical guidelines and accuracy of reimbursement. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Job Requirements

  • Three or more years' experience in claims processing or HCD medical billing experience with expert knowledge HCPCS codes.
  • Experience reading and interpreting contract language and fee schedules and medical record review.
  • Intermediate skills in Word and basic computer literacy.
  • Intermediate skills in Excel including comfort working with charts, graphs, and percentages.
  • Basic math skills with ability to do conversion calculations.
  • High school diploma obtained
  • Certified Pharmacy Technician or one or more of the following credentials: RHIA or CPC; preference given to those with multiple credentials.
  • Expert in HCPCS codes with advanced knowledge of medical terminology.
  • Experience with encoder tools and industry systems (FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers).

Benefits

  • 0-10% travel may be required.
  • For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

Related Categories

Related Job Pages

More Auditor Jobs

OtherRemoteTeam 10,001+Since 1894H1B No Sponsor

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are hiring for Social Compliance & Human Rights auditors. UL Solutions is seeking experienced professionals to join our mission of promoting responsible sourcing and protecting human rights across global supply chains. As a Responsible Sourcing Auditor, you’ll conduct on-site assessments at factories and facilities—helping leading brands ensure their suppliers meet labor, safety, and sustainability standards. This role goes beyond compliance—it’s a chance to influence how companies operate and improve lives around the world. You’ll be part of a forward-thinking team that values transparency, innovation, and your expertise. What You’ll Do - Perform independent, high-quality audits focused on labor practices, health and safety, and ethical sourcing. - Review documentation and prepare thoroughly for each site visit. - Deliver clear, professional audit reports in English—accurate, timely, and actionable. - Communicate findings respectfully with facility management, emphasizing solutions and continuous improvement. - Verify corrective actions and support supplier development. - Collaborate with global colleagues to ensure consistency and excellence. - Uphold UL’s Code of Conduct and maintain strict confidentiality. - Participate in training and apply feedback to enhance audit quality. Company Description UL Solutions (NYSE: ULS) transforms safety, security and sustainability challenges into opportunities for customers in more than 110 countries. UL Solutions delivers testing, inspection and certification services, together with software products and advisory offerings, that support our customers’ product innovation and business growth. The UL Mark serves as a recognized symbol of trust in our customers’ products and reflects an unwavering commitment to advancing our safety mission. We help our customers innovate, launch new products and services, navigate global markets and complex supply chains, and grow sustainably and responsibly into the future. Our science is your advantage. From life jackets to lawnmowers, toys to televisions, beauty and wellness, vitamins and supplements, we’re involved in almost every consumer product you can imagine. We work with some of the largest retailers in the world, performing market surveillance, auditing and inspecting the products we put in and on our bodies. We help customers ensure that not only are their products themselves safe, but their supply chains are using ethically and sustainably sourced materials. We build close relationships, providing advice and expertise to help them deliver safer products that meet the latest requirements and manufacture them fairly. Join our team and make your mark on products that shape people’s lives.

United States
$90K - $120K / year
Job Closed

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Auditor is responsible for conducting financial, operational, and compliance audits with a focus on government-funded programs, logistics operations, and contract performance. This role ensures adherence to federal, state, and local regulations while evaluating internal controls, procurement processes, supply chain activities, and contract compliance. The Auditor provides actionable recommendations to improve efficiency, accountability, and regulatory compliance. Job Duties and Responsibilities - Government Auditing & Compliance - Conduct audits in accordance with Government Auditing Standards (GAGAS/Yellow Book). - Evaluate compliance with federal regulations, including Uniform Guidance (2 CFR Part 200), FAR/DFARS, and agency-specific requirements. - Assess internal controls over financial reporting, procurement, and program operations. - Prepare detailed audit reports with findings, risk assessments, and corrective action recommendations. - Support external audits and regulatory reviews as needed. - Logistics & Supply Chain Oversight - Audit logistics operations including inventory management, transportation, warehousing, and asset accountability. - Evaluate supply chain controls to ensure efficiency, cost-effectiveness, and regulatory compliance. - Review property management systems and government-furnished property accountability. - Identify process improvement opportunities to reduce waste and mitigate risk. - Contract Management & Procurement Review - Audit contract lifecycle activities from solicitation through closeout. - Review contract files to ensure compliance with FAR, DFARS, and agency procurement policies. - Evaluate cost proposals, pricing structures, and contract modifications for accuracy and compliance. - Monitor contractor performance and compliance with terms and conditions. - Assess subcontractor oversight and vendor management processes. Qualifications - Strong knowledge of Government Auditing Standards (GAGAS). - Experience with FAR/DFARS and federal procurement regulations. - Demonstrated experience auditing logistics or supply chain operations. - Strong analytical, organizational, and report-writing skills. - Proficiency in audit management software and Microsoft Office Suite. - Attention to detail and investigative mindset. - Strong written and verbal communication skills. - Ability to interpret complex regulations. - Independent judgment and ethical integrity. - Collaboration with cross-functional and program teams. Requirements - Bachelor’s degree in Accounting, Finance, Business Administration, Logistics, or related field. - Minimum 5 years of experience in government auditing, logistics operations, or contract management. Preferred Qualifications - CPA, CIA, CFE, or DAWIA certification. - Experience working with federal agencies such as DoD, DHS, FEMA, or other government entities. - Knowledge of ERP systems (SAP, Oracle, or similar). - Experience with risk-based auditing methodologies. Work Environment - May require periodic travel to government sites, warehouses, or contractor facilities. - Ability to obtain and maintain security clearance may be required. Job Description Disclaimer This position description incorporates the job's core responsibilities. It recognizes that other related duties not specifically mentioned might also be performed and that not all responsibilities may be carried out depending on operational needs. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, national origin, disability, or status as a protected veteran. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position. Upon hire, secondary employment and other employment restrictions must be disclosed and approved. Tidal Basin Holdco, LLC, and its subsidiaries and affiliated companies, which include MLU Services, LLC are an Equal Employment Opportunity Employer.

United States + 171 moreAll locations: United States | Canada | Brazil | Colombia | Argentina | Chile | Venezuela | Bolivia | Ecuador | French Guiana | Guyana | Paraguay | Peru | Suriname | Uruguay | Mexico | Costa Rica | El Salvador | Guatemala | Honduras | Nicaragua | Panama | Dominican Republic | Puerto Rico | Bahamas | Guadeloupe | Haiti | Jamaica | Martinique | Montserrat | United Kingdom | Germany | France | Estonia | Portugal | Hungary | Poland | Ukraine | Romania | Bulgaria | Czechia | Slovakia | Belarus | Moldova | Sweden | Greece | Belgium | Italy | Ireland | Switzerland | Netherlands | Finland | Malta | Denmark | Lithuania | Croatia | Spain | Austria | Bosnia And Herzegovina | Iceland | Luxembourg | North Macedonia | Montenegro | Norway | Serbia | Slovenia | Albania | Cyprus | Latvia | Monaco | South Africa | Egypt | Algeria | Angola | Benin | Botswana | Burkina Faso | Burundi | Cameroon | Cabo Verde | Central African Republic | Chad | Congo | Côte D'ivoire | Democratic Republic of the Congo | Equatorial Guinea | Eritrea | Ethiopia | Gabon | Gambia | Ghana | Guinea | Guinea-bissau | Kenya | Lesotho | Liberia | Libya | Madagascar | Malawi | Mali | Mauritania | Mauritius | Mayotte | Morocco | Mozambique | Namibia | Niger | Nigeria | Réunion | Rwanda | Senegal | Seychelles | Sierra Leone | Somalia | Sudan | Eswatini | Tanzania | Togo | Tunisia | Uganda | Zambia | Zimbabwe | Georgia | Turkey | Israel | United Arab Emirates | Armenia | Azerbaijan | Bahrain | Iraq | Jordan | Kuwait | Lebanon | Oman | Qatar | Saudi Arabia | Palestine | Yemen | India | Japan | Philippines | Pakistan | Thailand | Singapore | Vietnam | Taiwan | Indonesia | Cambodia | Laos | Malaysia | Myanmar | South Korea | China | Afghanistan | Bangladesh | Bhutan | Kazakhstan | Kyrgyzstan | Maldives | Mongolia | Nepal | Sri Lanka | Tajikistan | Turkmenistan | Uzbekistan | Australia | Papua New Guinea | Kiribati | Palau | French Polynesia | Tuvalu | New Zealand
Job Closed
PsiquÊ RH logo

Audit Assistant

PsiquÊ RH

Soluções em Recursos Humanos e Gestão de Mão de Obra

Auditor99 days ago
Full TimeRemoteTeam 11-50Since 2005H1B No Sponsor

• Audit orders placed through our affiliate network, ensuring excellence for our clients and preventing fraud • Review documentation to support and ensure process accuracy (invoices, debit notes, declarations, and photos of the completed service) • Meet monthly audit targets

Brazil
R$2K - R$2.3K / month
Job Closed
KeyBank logo

Senior Audit Strategist

KeyBank

We'll meet you in the "am I making the most on my savings?" moment. Bank, borrow, invest—we have it all. Member FDIC.

Auditor99 days ago
OtherRemoteTeam 10,001+Since 1994H1B Sponsor

Location: For Those Who Work At Home, Ohio Job Summary The Senior Audit Strategist will, under the general direction of management, be responsible for the development of sustainable audit strategies for the completion of the three phases of a risk review: Planning, Fieldwork and Reporting. This will include completion of walkthroughs, interacting with line of business personnel, performing and documenting testing of internal controls, ensuring adherence to required laws and regulations, drafting findings, reporting deliverables, as well as identifying risks and controls associated with the various business functions. During the course of a risk review, the Senior Audit Strategist will be asked to serve as the lead on some of the most complex reviews, while managing assigned staff and delivering feedback on performance. The Senior Audit Strategist may also participate on ad-hoc projects, ongoing risk intelligence activities and risk review related trainings. Essential Functions - Demonstrate advanced understanding of audit concepts within planning, fieldwork and reporting, as well as workpaper documentation, audit findings, and audit reports. - Independently monitor for changes and best practices in area of subject matter expertise; provide updates to RRG senior leadership and/or staff as appropriate. - Exhibit advanced leadership skills by leading or providing oversight on complex stand-alone and integrated reviews or ad-hoc projects, while managing staff and delivering feedback on performance. - Prioritize and execute multiple assignments; identify obstacles within the scope of assignments; proactively communicate delays in assigned deliverables or additional capacity availability; effectively delegate work when necessary. - Consistently demonstrate advanced business writing skills and cohesively present information effectively to others including the delivery of audit findings and other audit matters to senior and executive management. - Exhibit a foundational understanding of product skills and business, industry and regulatory concepts and also be considered a Subject Matter Expert (SME) in a specific risk discipline, small number of products or lines of business. - Performs other duties as assigned; duties, responsibilities and/or activities may change or new ones may be assigned at any time with or without notice - Complies with all KeyBank policies and procedures, including without limitation, acting professionally at all times, conducting business ethically, avoiding conflicts of interest, and acting in the best interests of Key’s clients and Key. Education - Bachelor's Degree (preferred) - OR equivalent experience (required) Work Experience - 3+ years of relevant Audit experience (preferred) Licenses and Certifications - Certified Public Accountant (CPA) (preferred) - Certified Internal Auditor (CIA) (preferred) - Certified Fraud Examiner (CFE) (preferred) Skills - Ability to leverage business acumen to provide insights to leaders within area of expertise. - Ability to guide staff and deliver feedback on performance. - Develop relationships with clients; thoughtfully engage in networking with those on your team, within the RRG and across Key, to build lasting relationships. - Demonstrates the ability to contribute to an organizational culture of respect and personal accountability regarding Diversity and Inclusiveness. - Commitment to delivering high-quality service to internal and external stakeholders. - Effectively prioritize and manage multiple assignments and deadlines. - Identify, assess, and mitigate risks across business functions. - Ensure adherence to applicable laws, regulations, and internal policies. - Lead and oversee audit engagements, including planning, fieldwork, and reporting. - Draft and present audit findings and reports to senior and executive management. - Apply logical thinking to analyze data and identify trends or issues. - Identify root causes and develop effective solutions to complex issues. - Conduct independent evaluations of internal controls and processes. - Apply accounting principles and practices in audit procedures. - Supervise and mentor audit staff, providing performance feedback. Core Competencies - All KeyBank employees are expected to demonstrate Key’s Values and abide by Key’s Code of Conduct. Physical Demands - General Office - Prolonged sitting, ability to communicate face to face in person or on the phone with teammates and clients, frequent use of PC/laptop, occasional lifting/pushing/pulling of backpacks, computer bags up to 10 lbs. This position is NOT eligible for employment visa sponsorship for non-U.S. citizens. COMPENSATION AND BENEFITS This position is eligible to earn a base salary in the range of $80,000.00 - $150,000.00 annually. Placement within the pay range may differ based upon various factors, including but not limited to skills, experience and geographic location. Compensation for this role also includes eligibility for incentive compensation which may include production, commission, and/or discretionary incentives. Please click here for a list of benefits for which this position is eligible. Key has implemented an approach to employee workspaces which prioritizes in-office presence, while providing flexible options in circumstances where roles can be performed effectively in a mobile environment. Job Posting Expiration Date: 05/04/2026 KeyCorp is an Equal Opportunity Employer committed to sustaining an inclusive culture. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, pregnancy, disability, veteran status or any other characteristic protected by law. Qualified individuals with disabilities or disabled veterans who are unable or limited in their ability to apply on this site may request reasonable accommodations by emailing HR_Compliance@keybank.com. #LI-Remote

United States
$80K - $150K / year