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Inspiring a brighter work day for all.
Senior Auditor, Internal Audit – Operational Audits
Location
Costa Rica
Posted
105 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Senior Auditor, Internal Audit – Operational Audits
Workday
Your work days are brighter here. We’re obsessed with making hard work pay off, for our people, our customers, and the world around us. As a Fortune 500 company and a leading AI platform for managing people, money, and agents, we’re shaping the future of work so teams can reach their potential and focus on what matters most. The minute you join, you’ll feel it. Not just in the products we build, but in how we show up for each other. Our culture is rooted in integrity, empathy, and shared enthusiasm. We’re in this together, tackling big challenges with bold ideas and genuine care. We look for curious minds and courageous collaborators who bring sun-drenched optimism and drive. Whether you're building smarter solutions, supporting customers, or creating a space where everyone belongs, you’ll do meaningful work with Workmates who’ve got your back. In return, we’ll give you the trust to take risks, the tools to grow, the skills to develop and the support of a company invested in you for the long haul. So, if you want to inspire a brighter work day for everyone, including yourself, you’ve found a match in Workday, and we hope to be a match for you too. About the Team Our Internal Audit team isn't your typical audit group! We're a tight-knit global crew of passionate professionals who love what we do and have fun doing it. Driven by a strong moral compass, we're committed to doing the right thing, even when it's challenging. We're not just auditors, we're trusted advisors who proactively identify risks and opportunities to help shape the future of Workday. About the Role As we continue to scale, we're seeking a talented and experienced Senior Auditor to strengthen our internal control environment and contribute to our operational excellence. You will be instrumental in planning, executing, and reporting on risk-based operational audits across various functions within our fast-paced SaaS technology environment. You will have the opportunity to work collaboratively with key stakeholders, identify areas for improvement, and contribute directly to the company's success and growth. This role will require working with a distributed team, including team members from Pleasanton, California and Pune, India as well as various business partners across different functions and levels. Flexibility in working hours to accommodate international time zones is essential. Responsibilities - Execute all phases of operational audits, including planning, fieldwork, reporting, and follow-up, ensuring adherence to professional standards and audit methodologies. - Identify, assess, and document key operational risks and controls. - Embrace AI and data analytic tools in the execution of audit work. - Document audit findings clearly and concisely; develop practical and actionable recommendations for process improvements and risk mitigation. - Prepare audit reports that effectively communicate findings and recommendations to senior management and the Audit Committee. - Build and maintain strong relationships with key partners across the organization, including senior management, process owners, and external auditors. - Stay abreast of industry standard methodologies and emerging trends in operational risk management and internal auditing. - Contribute to the ongoing development and improvement of the Internal Audit department's methodologies, tools, and processes. About You We are looking for someone who embodies our company values, is a great teammate, has a positive attitude, and is comfortable working in a collaborative and results-oriented environment. We value individuals who are proactive, take initiative, and are passionate about their work. A sense of humor and the ability to have fun while maintaining high professional standards are also important. Basic Qualifications: - 5+ years of experience in Public Accounting, Internal Audit, or a related field at a medium to large, global public company Other Qualifications: - Bachelor's Degree in Accounting, Finance, Business Administration, or a related field. - CIA or other relevant professional certification. - Knowledge of Workday platform and/or SaaS experience is a plus! - Strong understanding of risk management frameworks and internal control principles (e.g., COSO). - Attention to detail and accuracy, especially with respect to audit work papers, audit reports, and presentation materials. - Strong written and verbal skills, and experience preparing workpapers, audit reports, and stakeholder presentations. - Proven ability to build strong relationships and establish trust with key partners across different functions and levels, fostering open communication and collaboration. - Excellent communication skills, with the ability to deliver clear, concise, and candid feedback, even in challenging situations, while maintaining a constructive and respectful approach. Ability to present complex information clearly and concisely to various audiences. - Takes ownership of responsibilities and deliverables, demonstrating a strong work ethic and commitment to delivering high-quality results. - Strong track record of successfully driving audit plans and delivering impactful recommendations. - Highly adaptable and flexible, with the ability to adjust to changing priorities, work effectively in ambiguous situations, and thrive in a fast-paced environment. Ability to work independently and as part of a team. Pursuant to applicable Fair Chance law, Workday will consider for employment qualified applicants with arrest and conviction records. Workday is an Equal Opportunity Employer including individuals with disabilities and protected veterans. Are you being referred to one of our roles? If so, ask your connection at Workday about our Employee Referral process!
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Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: - Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. - Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. - Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. The Opportunity: Job Description The Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, performing Peer to Peer reviews, Short Stay Reviews, Extended Observation. Provides for medical staff education and training as required. Provides periodic reports to Board, MEC and Joint Conference as deemed necessary. Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results. Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers. Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement. Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work. Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful and clear). Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results. Job Functions - Status determinations for hospitalized patients - Perform peer to peers with payors’ medical directors - Short inpatient stay reviews - Review observation patients daily - Build relationship with medical staff and leadership to get their buy-in with UM issues - Attend UM Committees as subject matter expert - Assist with denials and appeals as appropriate - Educate medical staff on UM topics - Partner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process - Track denial trends to assist the team evolve to meet new payor challenges Employment Qualifications: MD/DO Physician - Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale. - This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require. Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 - Innovation - Work-Life Flexibility - Leadership - Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: - Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs. - Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation. - Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. - Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com. This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range. Employment Disclaimers – Ensemble
• Conduct Appeals reviews of new evidence presented by auditees • Document Appeals results according to quality policies • Review audit documentation and conduct research • Provide corrections to rationale correlating with audit determinations • Contribute to continuous improvement feedback processes • Monitor, track, and report all work conducted
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Risk Adjustment Auditor Educator
Centene CorporationTransforming the health of the communities we serve, one person at a time.
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level. - Subject matter experts for proper risk adjustment coding and CMS data validation - Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met. - Analyze MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers. - Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. - This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc. - Works on additional risk adjustment audit requests (i.e. outside auditors’ requests). - Serves on the RADV Committee as subject matter experts. - Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists. - Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics. - Perform other duties as necessary. - Additional Responsibilities: - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Bachelor’s degree or equivalent experience required Candidate Experience: 5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred Preferred Other managed care experience Licenses and Certifications: A license in one of the following is required: One of the following licensures required at hire: CPC or CCS CRC required within the 1st year of employment CPMA preferred on the 2nd year of employment Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
