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Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Client Audit Project Lead - Remote
Location
United States
Posted
86 days ago
Salary
$82.4K - $137K / year
Seniority
Lead
No structured requirement data.
Job Description
Client Audit Project Lead - Remote
The Cigna Group
The job profile for this position is Operations Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Candidates who reside within 50 miles of the following locations may be asked to work in person: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, and Scottsdale, AZ. In this role, you will lead external client audit projects end to end, strengthen partnerships with audit firms and internal leaders, and turn audit insights into practical improvements across the enterprise. You will bring calm structure to complex requests, communicate clearly, and help raise our external client audit pass rate through smart, consistent execution. Responsibilities - Lead external client audit projects from intake through final response, keeping scope, timing, and stakeholders aligned. - Serve as the primary liaison between external audit firms and internal partners, ensuring clear, timely, and consistent messaging. - Clarify audit rights, negotiate audit scope when needed, and coordinate execution of required documents before any claim data is released. - Drive audit readiness for onsite and remote reviews by coordinating materials, participants, and logistics. - Own the response process to audit findings—compile inputs, confirm accuracy, and deliver a clear final report response. - Translate audit results into action: identify trends, quantify opportunities, and partner with leaders to prioritize improvement plans. - Support Claims Operations with risk, gap, and process insights; remove barriers through steady communication and follow-through. - Validate that improvements are implemented and sustained, helping improve the external client audit pass rate over time. Qualifications - Required - High School Diploma or G.E.D. - 3+ years of experience leading projects and/or operations work that involves cross-functional coordination, deadlines, and stakeholder communication. - Ability to manage multiple audit requests at once while staying organized and detail-oriented. - Strong written and verbal communication skills, including the ability to explain complex topics in plain language. - Comfort working with process, quality, and performance data to identify trends and improvement opportunities. - Proven ability to build trust and collaborate with partners across levels and teams. Qualifications - Preferred - Bachelor’s degree or equivalent experience. - Experience supporting external audits, claims operations, quality programs, or regulated data-sharing processes. - Demonstrated strength in project management methods, continuous improvement, and change adoption. - Confidence presenting analysis, recommendations, and progress updates to stakeholders. - Willingness to travel up to 25% as business needs require. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 82,400 - 137,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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We are Aaron’s - an industry leader in the sales and lease-to-own retail industry known for quality brand names and superior customer service. We provide our team members the opportunity to reach their full potential in a team-oriented, high-energy, recognition-based environment with competitive pay and benefits. This is much more than a job – it is a career with purpose. Senior Lead, Internal Audit The salary range is $87,500 to $90,000 annually and may also be eligible for incentive pay based on performance.* Actual salary may vary based on factors such as geographic location, experience, education, and skill level. This position is remote but may, from time to time, require travel to our Store Support Center in Atlanta, GA. Summary The IT & Process Audit Senior performs risk-based financial, operational, compliance, and IT audit activities across the organization. This role executes and supports integrated assurance and consulting engagements by evaluating business processes, information systems, and internal controls to assess risk, improve governance, and strengthen control effectiveness. The incumbent applies sound judgment, critical thinking, and technical expertise to deliver practical, value‑added recommendations while partnering effectively with business and technology stakeholders. Duties and Responsibilities - Independently lead and execute integrated audits that evaluate business processes, supporting systems, and related internal controls across financial, operational, compliance, and IT risk areas. This also includes planning, scoping and reporting. - Assess end‑to‑end risk and control effectiveness by analyzing how business processes, data, and technology interact to support reliable reporting and operations - Plan and perform risk assessments with audit executive management, identifying emerging risks, key processes, technology risks, dependencies, and control expectations - Design and execute integrated audits across IT, finance, and operations - Evaluate control design and operating effectiveness, including controls supporting SOX and other regulatory requirements - Supervise staff, delegates tasks, and provides coaching and feedback - Partner with business and IT stakeholders to understand complex workflows, identify root causes, and provide practical, value‑focused recommendations - Prepare high‑quality audit documentation and workpapers that clearly support conclusions and comply with audit standards - Prepare or detail review work papers in accordance with departmental standards - Draft audit observations and formal written reports, supporting clear messaging and actionable remediation plans for management - Meet face-to-face with Directors/VPs, communicate engagement progress, negotiate action plans, and manage stakeholder expectations - Track remediation of audit findings and validate that corrective actions effectively address identified risks - Perform advanced analytics (e.g., SQL/PowerBI) and have the ability to build data-driven models - Support special projects, advisory activities, and continuous improvement initiatives within Internal Audit - Assist in preparing quarterly Audit Committee communications, including timely follow-up with management on open audit recommendations - Participate in store audits and assist the store audit team with desktop audits and other operational audit procedures - Exhibit a high degree of judgment, determines significance of audit processes/issues, and manages escalations independently Education and Experience - Bachelor’s degree or higher in Information Systems, Accounting or a related field - Minimum 3–5 years of internal or external audit experience, including exposure to IT controls or integrated audits - 2-3 years of experience with a Big 4 or similar firm is preferred - Experience with Information Security, Privacy, IT Audit, Compliance & IT Management Standards: ISO27001/27002, PCI-DSS, SSAE-16 SOC1 & SOC2, SOX, NIST 800-53, COBIT, GAPP, & COSO - Experience supporting SOX, IT, compliance, or regulatory audits preferred - One or more of the following professional designations is preferred: Certified Information Systems Auditor (CISA), Certified Information Security Manager (CISM), Certified Information Privacy Professional (CIPP), Certified Information Systems Security Professional (CISSP), Certified Public Accountant (CPA) Required Skills & Competencies - Strong understanding of business processes, internal controls, risk assessment, and IT control concepts - Knowledge of IT general controls, application controls, and common audit frameworks - Project management skills with the ability to manage multiple priorities and meet deadlines - Proficiency in Microsoft Office (Word, Excel, PowerPoint); familiarity with audit management tools and basic data analytics (e.g., PowerBi, SQL) - Working knowledge of audit management and process flow software (e.g., JIRA) - Clear, concise written and verbal communication skills, including explaining complex topics to non‑technical audiences - Sound professional judgment, attention to detail, and commitment to audit quality - Collaborative mindset with the ability to build effective relationships across business and IT teams - Willingness to travel on a limited basis (approximately 15%) - Professional ethics – Adheres to Aaron’s key policies, practices and procedures; applies ethical principles and values to the activities being audited - Internal audit management – Strives for quality and excellence and encourages others to do the same - International Professional Practices Framework – Maintains current knowledge of the International Professional Practices Framework (IPPF), the authoritative guidance issued by The Institute of Internal Auditors; develops deep understanding of Aaron’s audit methodology, policies and procedures, which are based on the IPPF - Governance, risk and control – Solid foundation in technical aspects of auditing (knowledge of general accounting, business processes, internal controls, risk assessment and/or other related general/application controls) - Communication – Understanding of effective communication concepts, tools and techniques; ability to effectively transmit, receive and accurately interpret ideas, information and needs through the application of appropriate communication behaviors - Relationships and collaboration – Nurtures and builds effective partnerships with audit engagement clients to achieve results; team player, comfortable working on multiple teams/projects simultaneously and independently, as needed - Critical thinking – Understanding of the issues related to the decision-making process; ability to analyze situations fully and accurately, and reach productive decisions - Internal audit delivery – Demonstrates efficiency and persistence, managing own time and ensuring engagement deadlines and objectives are met; follows up with management to ensure that management actions have been effectively implemented or that senior management has accepted the risk of not taking action; understanding of the necessity and value of accuracy and attention to detail; ability to process information with high levels of accuracy - Improvement and innovation – Champions change, continuous improvement and innovation and supports others in the pursuit of these The above statements are intended to describe the general nature and level of work performed by employees assigned to this classification. The statements are not intended to be an exhaustive list of all job duties performed by employees assigned to this classification. *Note that the pay range provided above is the lowest to highest rate we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, seniority, geographic location, performance, shift, travel requirements, sales or revenue-based metrics, any collective bargaining agreements, and business or organizational needs. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. **Benefits vary based on FT and PT employment status. Aaron’s Total Rewards Our team members are our greatest asset. As an expression of our appreciation, Aaron’s is proud to offer outstanding career training, competitive performance incentives, excellent advancement opportunities, and a distinctive benefits package which includes: - Sundays off - Employee assistance program - Employee purchase program with exclusive discounts - Physical and financial well-being programs - Tuition reimbursement - Employee Business Resource Groups - 401(k) plan with contribution matching - Paid time off, including vacation days, sick days, and holidays - Life and disability insurance - Medical, dental and vision insurance - Paid paternal leave - Pay on Demand **Benefits vary based on full- and part-time employment status. Note that the pay range provided above is the lowest to highest rate we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, seniority, geographic location, performance, shift, travel requirements, sales or revenue-based metrics, any collective bargaining agreements, and business or organizational needs. About Aaron’s At Aaron’s we offer sales and lease-to-ownership of specialty items including furniture, consumer electronics, home appliances, and accessories throughout the United States and Canada. Our customers shop at Aaron’s for the same reason you should choose us for the next step in your career – our ability to positively influence people’s lives. If you are looking for a company with the passion and dedication to make a difference in the lives of customers and team members alike, join us today. Aaron’s is committed to creating a diverse and inclusive work environment, celebrates our team members’ differences, and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, pregnancy, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, military duty, gender expression, genetic information, or any other protected class. Candidates who require accommodation during the recruitment process should contact hrsupport@aarons.com.Aaron’s is an Equal Opportunity Employer. #LI-Remote#Indeed-Full-Time
Description Required: 5+ years of experience in inpatient coding auditing or compliance Location: Remote Job Summary: The Inpatient Coding Auditor is responsible for auditing inpatient coding and DRG assignment to ensure accurate ICD-10-CM/PCS coding, documentation support, and compliance with official guidelines and payer requirements. This role tracks audit outcomes, supports corrective actions, and provides education to improve coding quality and reduce audit risk. Responsibilities include, but are not limited to: - Review entire medical record to confirm correct assignment of ICD-10-CM/PCS coding, sequencing and POA to ensure proper assignment of MS-DRG/APR-DRG. - Review clinical documentation for guideline compliance, clinical support, and accurate capture of CC/MCC and key secondary diagnoses and procedures. - Identify trends, root causes, and compliance risks; recommend corrective actions and process improvements in collaboration with coding leadership and CDI. - Work closely with leadership create and prepare detailed audit reports, including findings, financial impact considerations, and error-rate metrics; track follow-up actions and re-audit results. - Provide education and feedback to inpatient coders and CDI partners; develop reference tools and training materials. - Support external audits and payer requests (e.g., RAC/DRG audits) and assist with appeal support when needed. - Stay current with CMS IPPS changes, Coding Clinic guidance, official coding guidelines, and payer policy updates. - Ensure accurate abstraction of data elements impacting reimbursement and reporting (e.g., discharge disposition, admission source, procedure dates). - Maintain audit tools, policies, and procedures; assist with continuous improvement initiatives. - Maintain established productivity standards by PF Concepts or client - Maintain HIPAA compliance and protect patient confidentiality in all work activities. Compensation: - $40.00–$44.00 per hour, depending on experience. Schedule: - Per diem / as needed; no guaranteed minimum hours. Requirements Qualifications: - Bachelor’s Degree or Associate's Degree in Health Information Management or related field; bachelor's degree preferred - Credentials from AHIMA or AAPC, AHIMA preferred, AAPC considered with facility coding experience. - 5+ years of recent inpatient acute-care coding experience with auditing/DRG validation experience preferred. - Expert knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGs, POA, CC/MCC capture, and official coding guidelines/Coding Clinic. - Strong analytical skills and ability to interpret clinical documentation and support audit conclusions. - Ability to prepare detailed written reports and communicate findings effectively. - Proficiency with EHR and encoder/coding tools and Microsoft Excel/Office. - Effective communication and coaching skills to deliver coder education and corrective action follow-up. - Active coding certification required (CCS or CIC); RHIT/RHIA and CDIP are a plus. - Proficiency with multiple applications: Oracle, Epic, Meditech, Powerchart, Soarian Financials, Clintegrity, Solventum 360, etc
Role Description This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding/auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting and services delivered. Responsibilities - Audits Outpatient and Specialty Claims - Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims. - Draws on advanced coding expertise and industry knowledge to substantiate conclusions. - Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues. - Effectively Utilizes Audit Tools - Utilizes advanced proficiency, Cotiviti encoder and audit tools required to perform duties. - Enters claim into Cotiviti system accurately and in accordance with standard procedures. - Meets or Exceeds Standards/Guidelines for Productivity - Maintains production goals, accuracy, and quality standards set by the audit for the auditing concept. - Meets or Exceeds Standards/Guidelines for Quality - Achieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation. - Identifies New Claim Types - Identifies potential claims outside of the concept where additional recoveries may be available. - Suggests and develops high quality, high value concepts and/or processes improvement, tools, etc. - Recommends New Concepts and Processes - Has broad in-depth knowledge of client, contract terms and complex claim types gained from extensive healthcare auditing experience. - Suggests, develops and implements new ideas, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction. - Evaluates information and draws logical conclusions. - Complete all responsibilities as outlined on annual Performance Plan. - Complete all special projects and other duties as assigned. - Must be able to perform duties with or without reasonable accommodation. Qualifications - Education: Associate or bachelor’s degree in Health Information Management (RHIA or RHIT) or equivalent combination of relative work experience. - Certifications/Licenses: Coding Certification required and maintained i.e. CPC, CIC, CCS, CCS-P, RHIA or RHIT. - Experience: 5 to 7 years of experience with clinical medical record coding or auditing and a working knowledge of HIPAA Privacy and Security Rules and CMS security requirements. - Working knowledge of HIPAA Privacy and Security Rules, CMS security requirements and clinical medical record coding or auditing. - A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. - Ability and desire to utilize base coding and clinical auditing knowledge to learn and become proficient in a variety of outpatient and specialty review types. - Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. - Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes. - Excellent verbal and written communication skills. - Ability to work well in an individual and team environment. Requirements - Mental Requirements: Communicating with others to exchange information. - Assessing the accuracy, neatness, and thoroughness of the work assigned. - Physical Requirements and Working Conditions: Remaining in a stationary position, often standing or sitting for prolonged periods. - Repeating motions that may include the wrists, hands, and/or fingers. - Must be able to provide a dedicated, secure work area. - Must be able to provide high-speed internet access/connectivity and office setup and maintenance. - No adverse environmental conditions are expected. Benefits - Base compensation is paid hourly at $45.67/hour (95k annualized). - Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. - This role is eligible for discretionary bonus consideration. - Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. - Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including: - Medical, dental, vision, disability, and life insurance coverage. - 401(k) savings plans. - Paid family leave. - 9 paid holidays per year. - 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.
• Conduct evaluations and audits at training providers • Assess program approvals • Review program and provider documentation as part of approval procedures • Document audit and evaluation reports • Prepare well-founded assessment reports for submission to our internal decision-making process • Communicate with providers to clarify queries or request missing information • Collaborate with the certification body in the context of certification decisions • Provide subject-matter input to further develop our audit and evaluation methodology • Optional involvement in special cases, expert opinions, or appeal procedures


