Primary Duties and Responsibilities The Claims Auditor is responsible for performing pre-payment and post-payment audits ensuring financial and processing accuracy, compliance with regulatory and health plan requirements of claims processed. The Claims Auditor is responsible for auditing and confirming accuracy of the loading of: - Fee schedules - Provider contracts - Payor contracts - Benefits - Code changes - System enhancements Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year. For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy. Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes. Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California. To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/. Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.

Job Summary The work of a Sr. Coding & Coding Quality Educator relates to practices and principles associated with medical record auditing and utilizes various techniques in examining, evaluating and providing feedback and training to various stakeholders (certified coders, physician's practices, etc.) Key responsibilities include setting up a standard medical record auditing process and assisting in all matters relating to implementation of coding quality and coding training programs for Coders and Physicians, creating an integrated Program plan to carry out goals and managing/monitoring progress of the program execution. Essential Functions - The essential functions listed represent the major duties of this role, additional duties may be assigned. - Work closely with and coach certified coders and assist in assessing the strengths and weaknesses, ensuring that quality issues translate into timely training and ongoing coding reinforcement to the coders. - Verify, document and communicate quality audit results, develop audit reports and evaluate the effectiveness of corrective action plans and follow up. - Identify coding opportunities and make recommendations to improve internal controls and operational effectiveness and efficiency. - Assist in preparation & development of provider training tools and lead and conduct educational and training programs for physician training on various aspects of documentation and ICD-10-CM coding. - Perform review of specific provider/provider group medical records, develop audit reports and communicate audit results to external physician groups and physician group administration. - Coordinate quality audit program reporting and provider coding training with appropriate areas within Medicare Advantage Risk Adjustment and promote teamwork. - Responsible for the development and ongoing, end-to-end management of the quality audit program ensuring that QA activities and measurements are objective. - Responsible for quality audit program performance and adherence to established ICD-10-CM and CMS-HCC coding guidelines, ensuring compliance with all regulations. - Develop and maintain appropriate reporting, identifying metrics that will reflect true audit program performance. - Gain management concurrence and support for recommended control improvements. - Test and improve training program based upon experience and feedback. - Gather information, constantly update knowledge on various changes that are happening in the field of quality audit and modify coding guidelines to incorporate new knowledge. Share changes with coders as well as physician practices partners. - Manage multiple complex issues and projects simultaneously. - Work collaboratively with other areas of Revenue Program Management to identify, implement and monitor continuous improvement opportunities. - May require travel 0-25% of the time to Florida Blue office locations and provider engagements. Required Experience: 5+ years related work experience. Experience Details: Professional coding including proficiency in ICD-10-CM coding guidelines and risk adjustment HCC coding Related Bachelor’s degree or additional related equivalent work experience AAPC Certified Professional Medical Auditor (CPMA) certification AAPC Certified Professional Coding Instructor (CPC-I) certification 1 Year Knowledge of CMS-HCC risk adjustment data validation process. Organization and time management skills Demonstrate written and verbal communication skills. Preferred Qualifications: Knowledge of government regulations, requirements, and standards related to the management of health information. Knowledge of Scope and Statistical Sampling Methodologies Detail-oriented, commitment to accuracy, ability to problem solve. Working knowledge of MS Office (Excel, Word, PowerPoint) General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally What We Offer: As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: - Medical, dental, vision, life and global travel health insurance; - Income protection benefits: life insurance, short- and long-term disability programs; - Leave programs to support personal circumstances; - Retirement Savings Plan including employer match; - Paid time off, volunteer time off, 10 holidays and 2 well-being days; - Additional voluntary benefits available; and - A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Annualized Salary Range: $77,600 - $126,100 Typical Annualized Hiring Range: $77,600 - $97,000 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Are you highly motivated, hard-working, and seeking to join a growth-focused consulting & engineering firm? Are you looking for a company that will invest in your development and grow your professional skills? If so, consider a career with Apex! Powered by record sales, extraordinary client retention, strategic acquisitions, and an entrepreneurial spirit, Apex Companies is one of the fastest growing engineering and environmental consulting firms in the US. We were recently recognized by the Zweig Group as one of the fastest growing firms in the AEC industry. We take pride in providing our clients with exceptional service and have earned numerous awards for project excellence. We continue to grow, and we want you to grow with us. Environmental Market Leader – South Atlantic Division Locations: North Carolina, South Carolina, Georgia, Florida Work Model: Remote Position Overview The Environmental Market Leader – South Atlantic Division is a high‑impact, growth‑oriented leadership role responsible for expanding Apex’s environmental consulting business across our South Atlantic Division (Carolinas, Georgia, and Florida). This position is ideal for a senior seller‑doer who thrives in externally facing roles, enjoys building trusted client relationships, and wants to directly influence the growth and direction of a business. This role offers the opportunity to help shape Apex’s environmental strategy in the South Atlantic by driving organic growth, deepening key client relationships, and leveraging Apex’s national technical capabilities. The Practice Leader will collaborate closely with Division leadership, National Account Managers, and technical teams while maintaining a strong personal presence in the market. The Opportunity With the chance to engage with clients on an ongoing basis and help shape Apex’s environmental footprint in the region, this is a high‑visibility role offering significant growth potential and long‑term career advancement. The successful candidate will operate entrepreneurially while being supported by Apex’s established platform, leadership team, and national resources. Your Responsibilities as a Environmental Market Leader: - Drive growth of Apex’s environmental consulting services across the South Atlantic, with accountability for pipeline development, opportunity creation, and revenue generation; looking for a focus on site characterization, investigation, and remediation for industrial/commercial and municipal clients. - Serve as a client-facing leader and trusted advisor, maintaining active engagement with key industrial, commercial, and municipal clients to both long-term partners and new business opportunities. - Identify, shape, and pursue new opportunities by leveraging your professional network and collaborating with Apex’s National Account Managers, Regional Commercial Leaders, Service Line Leaders, and local technical teams. - Lead and influence pursuit strategy, go/no‑go decisions, proposal development, and contract negotiations for strategic opportunities. - Provide technical and strategic leadership on select environmental engagements, ensuring quality execution while maintaining a primary focus on client satisfaction and repeat business. - Work closely with National Account Managers and Commercial Line Leaders to build and execute on account plans and develop opportunities across the Division. - Direct high-visibility projects, ensuring technical excellence, regulatory compliance, and successful environmental outcomes. - Collaborate and communicate effectively on key technical concepts to regulators, stakeholders, and teaming partners. - Manage program and project performance with a focus on quality, innovation, and client satisfaction. - Travel to client locations as needed for meetings and business development. What we're looking for: Industry Experience - 12+ years of experience in environmental consulting or industry with progressive responsibility in client-facing, seller-doer roles. - Professional registration as a PE or PG in North Carolina, South Carolina, Georgia or Florida - Proven success in client engagement, building opportunities through existing relationships, and managing complex environmental programs. - Deep technical expertise with site characterization, investigation, remediation, and regulatory strategy. - Strong communication skills — both technical and strategic — with a proven ability to gain credibility with regulators, stakeholders, and clients. - A passion for mentoring, leadership, and advancing a culture of excellence and safety. - Established professional network within the South Atlantic market.  Sales and Growth Experience - Demonstrated success growing client accounts and developing new business in a consulting environment. - Track record of identifying opportunities, shaping pursuits, and converting relationships into revenue. - Strong commercial acumen with the ability to align technical solutions to client business needs. - Commitment to a growth mindset and long‑term client relationship development Leadership Attributes - Confident, collaborative leader with strong communication and presentation skills. - Ability to operate independently while thriving in a team-based, cross-functional environment. - Passion for mentoring and developing high performing technical and seller-doer teams. - Comfortable operating in a fast paced, PE backed environment focused on performance and growth. Why you'll love working for us: - Company-subsidized medical and dental. - Company-paid life, short, and long-term disability. - 401k match, tuition assistance, and more. - Cross-training and the ability to work on a variety of projects. - Performance-based bonuses or other incentives. - Working with the best and brightest in the industry. - 2,000+ employee national firm with 70+ locations across the US. Apex Job Title: Principal Req ID: 11427 #LI-TB1 We believe in equality for all and celebrate the diversity and differences of our employees, customers, and communities. We do not discriminate based on gender, race or color, ethnicity or national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status, or any other applicable characteristics protected by law. Apex aims to make apexcos.com accessible to all users. If you have a disability or special need that requires accommodation to navigate our website or complete the application process, please contact Talent@apexcos.com or (301) 417-0200. Likewise, feel free to reach out to us if you would like to view or discuss Apex policy related to equal employment opportunity or have any related concerns. EO/AA/VEV/Disabled Employer TO ALL RECRUITMENT AGENCIES: Apex Companies does not accept unsolicited agency resumes. Please do not forward resumes for any of our job postings to our career’s sites, or to any employees of Apex Companies or affiliates. Apex Companies is not responsible for any fees related to unsolicited resumes.

Are you highly motivated, hard-working, and seeking to join a growth-focused consulting & engineering firm? Are you looking for a company that will invest in your development and grow your professional skills? If so, consider a career with Apex! Powered by record sales, extraordinary client retention, strategic acquisitions, and an entrepreneurial spirit, Apex Companies is one of the fastest growing engineering and environmental consulting firms in the US. We were recently recognized by the Zweig Group as one of the fastest growing firms in the AEC industry. We take pride in providing our clients with exceptional service and have earned numerous awards for project excellence. We continue to grow, and we want you to grow with us. Environmental Market Leader – South Atlantic Division Locations: North Carolina, South Carolina, Georgia, Florida Work Model: Remote Position Overview The Environmental Market Leader – South Atlantic Division is a high‑impact, growth‑oriented leadership role responsible for expanding Apex’s environmental consulting business across our South Atlantic Division (Carolinas, Georgia, Florida). This position is ideal for a senior seller‑doer who thrives in externally facing roles, enjoys building trusted client relationships, and wants to directly influence the growth and direction of a business. This role offers the opportunity to help shape Apex’s environmental strategy in the South Atlantic by driving organic growth, deepening key client relationships, and leveraging Apex’s national technical capabilities. The Practice Leader will collaborate closely with Division leadership, National Account Managers, and technical teams while maintaining a strong personal presence in the market. The Opportunity With the chance to engage with clients on an ongoing basis and help shape Apex’s environmental footprint in the region, this is a high‑visibility role offering significant growth potential and long‑term career advancement. The successful candidate will operate entrepreneurially while being supported by Apex’s established platform, leadership team, and national resources. Your Responsibilities as a Environmental Market Leader: - Drive growth of Apex’s environmental consulting services across the South Atlantic, with accountability for pipeline development, opportunity creation, and revenue generation; looking for a focus on site characterization, investigation, and remediation for industrial/commercial and municipal clients. - Serve as a client-facing leader and trusted advisor, maintaining active engagement with key industrial, commercial, and municipal clients to both long-term partners and new business opportunities. - Identify, shape, and pursue new opportunities by leveraging your professional network and collaborating with Apex’s National Account Managers, Regional Commercial Leaders, Service Line Leaders, and local technical teams. - Lead and influence pursuit strategy, go/no‑go decisions, proposal development, and contract negotiations for strategic opportunities. - Provide technical and strategic leadership on select environmental engagements, ensuring quality execution while maintaining a primary focus on client satisfaction and repeat business. - Work closely with National Account Managers and Commercial Line Leaders to build and execute on account plans and develop opportunities across the Division. - Direct high-visibility projects, ensuring technical excellence, regulatory compliance, and successful environmental outcomes. - Collaborate and communicate effectively on key technical concepts to regulators, stakeholders, and teaming partners. - Manage program and project performance with a focus on quality, innovation, and client satisfaction. - Travel to client locations as needed for meetings and business development. What we're looking for: Industry Experience - 12+ years of experience in environmental consulting or industry with progressive responsibility in client-facing, seller-doer roles. - Professional registration as a PE or PG in North Carolina, South Carolina, Georgia or Florida - Proven success in client engagement, building opportunities through existing relationships, and managing complex environmental programs. - Deep technical expertise with site characterization, investigation, remediation, and regulatory strategy. - Strong communication skills — both technical and strategic — with a proven ability to gain credibility with regulators, stakeholders, and clients. - A passion for mentoring, leadership, and advancing a culture of excellence and safety. - Established professional network within the South Atlantic market.  Sales and Growth Experience - Demonstrated success growing client accounts and developing new business in a consulting environment. - Track record of identifying opportunities, shaping pursuits, and converting relationships into revenue. - Strong commercial acumen with the ability to align technical solutions to client business needs. - Commitment to a growth mindset and long‑term client relationship development Leadership Attributes - Confident, collaborative leader with strong communication and presentation skills. - Ability to operate independently while thriving in a team-based, cross-functional environment. - Passion for mentoring and developing high performing technical and seller-doer teams. - Comfortable operating in a fast paced, PE backed environment focused on performance and growth. Why you'll love working for us: - Company-subsidized medical and dental. - Company-paid life, short, and long-term disability. - 401k match, tuition assistance, and more. - Cross-training and the ability to work on a variety of projects. - Performance-based bonuses or other incentives. - Working with the best and brightest in the industry. - 2,000+ employee national firm with 70+ locations across the US. Apex Job Title: Principal Req ID: 11427 #LI-TB1 We believe in equality for all and celebrate the diversity and differences of our employees, customers, and communities. We do not discriminate based on gender, race or color, ethnicity or national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status, or any other applicable characteristics protected by law. Apex aims to make apexcos.com accessible to all users. If you have a disability or special need that requires accommodation to navigate our website or complete the application process, please contact Talent@apexcos.com or (301) 417-0200. Likewise, feel free to reach out to us if you would like to view or discuss Apex policy related to equal employment opportunity or have any related concerns. EO/AA/VEV/Disabled Employer TO ALL RECRUITMENT AGENCIES: Apex Companies does not accept unsolicited agency resumes. Please do not forward resumes for any of our job postings to our career’s sites, or to any employees of Apex Companies or affiliates. Apex Companies is not responsible for any fees related to unsolicited resumes.