Role Description The Senior Clinical Quality Auditor will be responsible for supporting care management products and operations reporting to the Manager of Quality for UMR. You will provide general support in reviewing and researching program processes for overall staff compliance. In addition to fostering teamwork and collaboration, much of your work will involve review of calls and documentation of elements of the call. Solid auditing skills are essential. You will also need effective communication skills, and the ability to effectively collaborate with your team members. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Participate in audit preparation, analysis and review complex business processes, systems, workflows, SOPs, policies and procedures to identify and document risks and trends that may be non-compliant with contracts and or statutory requirements. - Monitor Program staff for compliance to established processes, policies, and guidelines; and identify opportunities to improve process performance. - Implement and complete UMR UM and care management quality audits and provide coaching to staff and program management based on evaluation results. - Participate in effective analysis of audit results and identify trends impacting program compliance. - Collaborate in the design, creation and implementation of quality improvement projects and initiatives. - Utilize applicable systems/tools to maintain and document Quality metrics/outcomes. - Participate in Inter-Rater Reliability sessions with internal stakeholders to ensure evaluation consistency. - Other responsibilities as assigned. Qualifications - Current, unrestricted RN license in state of residence. - 3+ years of proven experience in health plan quality improvement identifying areas of opportunity. - Demonstrated experience auditing clinical programs in a managed care setting. - Intermediate proficiency with Microsoft Word, Excel and PowerPoint. Requirements - Experience working for UMR. Soft Skills - Solid interpersonal skills and high level of professionalism. - Excellent problem-solving skills with strong attention to detail. - Excellent written and verbal communication skills. - Ability to work independently in a remote environment and deliver exceptional results. - Excellent time management and work prioritization skills. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Salary Information The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

• Ejecución de auditorías SGSST. • Auditorías de cumplimiento legal SST. • Inspecciones de campo. • Verificación documentaria. • Elaboración de informes y hallazgos. • Seguimiento de levantamiento de observaciones. • Emisión de constancias de auditoría. • Coordinación con CSST del cliente.

Role Description Lead Quality Systems Auditor will act as a Subject Matter Expert (SME) in inspection activities for Quality System (QM) audits required by the corporate quality systems audit program, including planning, preparation, execution, follow-up, closure, and trend analysis. Responsible for continuous improvement of the audit program with an emphasis on maintaining compliance with applicable regulations, standards, and pertinent Fresenius Medical Care policies and procedures to drive continuous quality improvement. Support external quality management inspections at Fresenius Medical Care sites and distribution centers as SME, including preparation, conduct and follow-up, and coordinate with various sites and local quality heads, to ensuring readiness for inspections. Qualifications - Bachelor’s degree or an equivalent combination of education and experience required (advanced degree preferred) - 3rd party auditor training (e.g. ASQ-CQA, ASQ-CBA, RABQSA, ISO 9001:2015) or equivalent education and experience required - Minimum 10+ years’ experience in quality management, regulatory compliance, quality engineering and auditing in the pharmaceutical or medical device sector or related industries - Several years of practical experience in FDA inspections and cooperation with US regulatory authorities (experience with additional Health Authorities preferred) - Knowledge of current regulations for pharmaceutical and medical devices (e.g., 21 CFR Part 820, Part 210/211, Part 11, Part 803, Part 806, Canadian SOR/98-282, Mexican NOM-241-SSA1, MDSAP, CE Marking) required - Knowledge of current standards and guidelines for pharmaceutical and medical devices (e.g., ISO 13485, ICH Q7/Q10, ISO 14971, ISO 10993, IE 62366, GxP) required - In-depth knowledge in the interpretation of FDA guidelines, Good Manufacturing Practices (GMP) and relevant quality standards for pharmaceuticals and medical devices - Expertise in reviewing, revising, and writing Standard Operating Procedures (recent auditing expertise preferred) - Demonstrated expertise in specialized processes related to drug and device manufacturing, particularly in areas of sterilization, bag manufacturing, NC/CAPA, corrections and removals and formulation (experience outside of auditing/inspecting desired) - Profound experience with best practices in product design / design change, risk management and CAPA management - Demonstrated broad expertise related to the principles and application of quality conformity and regulatory compliance - Strong analytical and conceptual skills - Ability to identify risks and compliance gaps and develop appropriate actions - Strong problem-solving skills - Experience in training and mentoring staff - Excellent communication and writing skills when interacting with interdisciplinary teams, international authorities and other stakeholders - Ability to work both independently with direction and within project teams to attain goals - High level of commitment, flexibility and sense of responsibility - Willingness to travel internationally - Proficiency in using Microsoft Office applications required Requirements - Responsible for quality systems audits, schedules, plans, conducts, and leads audits in accordance with the global QS audit program - Lead and manage internal and corporate audit program for all assigned sites, with a focus on planning, scheduling, and implementation in close coordination with sites and local quality heads - Perform QM audits required by the corporate quality systems audit program, including planning, preparation, execution, follow-up, closure, and trend analysis - Works on complex issues where analysis of situations or data requires an in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results - Ensures audit activities are in compliance with FME policies and procedures and applicable regulatory requirements - Develop and maintain audit processes and documentation to ensure conformity with FME policies and procedures and compliance with applicable regulations - Track, manage, and resolve Non-Conformances (NC’s) and Corrective and Preventive Actions (CAPAs) arising from audits - Provide status reports on overdue, open, and closed audit outcomes to relevant stakeholders - Recommend modifications to existing quality or production systems to optimize product quality while ensuring compliance with regulatory requirements and internal Fresenius procedures - As a SME, support FME sites and with gap analysis for projects or local QM implementations - As a SME, serve as the primary support for inspection readiness, ensuring sites are well-prepared for inspections - Support training and qualification initiatives for new auditors, ensuring they are adequately prepared to conduct internal audits in accordance with FME policies and procedures - Performs other related duties as assigned Benefits - Base Rate: $105,000 - $160,000 - Comprehensive benefits package including medical, dental, and vision insurance - 401(k) with company match - Paid time off - Parental leave - Potential for performance-based bonuses depending on company and individual performance

Role Description Build your Career. Make a Difference. Presbyterian is hiring a skilled Remote Pro Fee Auditor/Educator to join our team. Type of Opportunity: Full time Job Exempt: Yes Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America) Responsibilities: - Supports the Coding and documentation quality assurance (CDQA) team with minimal supervision. - Ensures compliance with enterprise-wide and department coding policies and procedures for PHS. - Adheres to all external regulatory agency coding rules and regulations. - Demonstrates proficiency in performing and managing on-site internal audits or reviews. - Serves as a resource on documentation, coding, billing, and coding compliance questions. - Works on special coding compliance related projects and develops educational programs. - Disseminates information to PHS/PMG departments and develops educational tools for compliance. - Provides support via auditing and training for corrective action plans for low performers. - Performs medical record and billing reviews of denied and appealed claims. - Coordinates review and tracking of appealed claims, including communication with affected payers. - Researches and interprets all regulatory agency regulations. - Liaison to various departments addressing coding, auditing, compliance, and training issues. - Maintains accurate, complete, and timely documentation in electronic or hard copy form. - Adapts to frequently changing work priorities and schedules. - Maintains up-to-date technical knowledge of legal and regulatory information. - Researches coding, billing, and charging compliance issues; recommends corrective action plans. - Identifies risks and lost revenue opportunities due to coding and documentation errors. - Assists in the creation of the CDQA Annual Audit Work-plan. - Exercises independent judgment in determining the reliability of data reviewed. - Responds to inquiries and requests regarding coding and auditing issues daily. Qualifications - High school diploma/GED required. - Must possess at least one of the following licenses/certifications: RHIT, RHIA, CPC, CCS. - A minimum of three (3) years experience in coding and/or auditing required. - Audit experience preferred. - Excellent written and verbal communication skills. - Detail and results oriented. - Ability to work independently and make independent decisions. - Knowledge of medical terminology, ICD-9, CPT-4, and HCPCS required. - Proficient knowledge of Medicare, Medicaid, and other third-party payer documentation, coding, and billing regulations. - Excellent organizational and planning skills. - Computer skills, especially with Microsoft Word, PowerPoint, and Excel applications. - Strong written and verbal communication skills to articulate complex regulatory information. - Personal presence characterized by honesty, integrity, and the ability to inspire others. Benefits - Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits. - Employee Wellness rewards program designed to enhance health and well-being. - Opportunities to earn gift cards and more by participating in wellness activities. Company Description Presbyterian exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees, including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services