• Ensures the integrity and accuracy of claims processes and protocols. • Collects data for audits/investigations into claims, utilizing analytical skills and attention to detail. • Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. • Adheres to industry regulations and policies for managerial follow-up. • Analyzes data to assess the validity of claims. • Provides accurate recommendations to management for claim resolution and closure. • Documents and inputs all findings while preparing comprehensive reports that may be used for legal or audit/investigative purposes.

• Reviews patient records for correct ICD-10-CM/PCS codes, CPT Codes, POA assignment and MS-DRG assignment according to established guidelines and scores appropriately, if applicable. • Works with CDIS on DRG assignment and educates on missed Query opportunities. • Reviews discharge summaries for coding accuracy. • Appeals RAC DRG review charts.

Title: Senior Technology Auditor Location: Pleasanton United States Full Time Job Description: 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 Internal Audit is an independent and objective assurance and consulting function. We support Workday's key business objectives and core values by using a systematic, risk‑based approach to evaluate and improve operations, governance, risk management, and internal controls, including emerging risks in cloud technology, security, and AI. About the Role We are seeking an experienced and highly curious Senior Technology Auditor to lead technology‑, security‑, and AI‑related audits. This role is ideal for someone energized by the new risk frontier of AI and who has a track record of building and scaling AI‑enabled tools and workflows for audit teams (not just for personal use). You will: - Help lead audits focused on technology, security, and AI/ML/LLM‑powered systems and services. - Design and implement AI‑enabled solutions that improve how the audit team plans, tests, and reports. - Act as a collaborative evangelist for modern audit techniques, helping move the function beyond the status quo. You will partner closely with stakeholders across the business, provide deep technical and AI expertise, and serve as a trusted advisor on risks and controls. Duties and Responsibilities - Plan and execute technology, security, and AI‑related audits across a diverse set of systems and platforms, including risk assessment, scoping, fieldwork, documentation, testing, and reporting. - Identify and assess technology and AI risks (e.g., generative AI, ML models, automated decisioning, AI‑enabled third‑party services) and translate them into clear control expectations and audit procedures. - Design, build, and maintain AI‑enabled tools, scripts, and workflows (e.g., LLM‑assisted testing, automated analytics, continuous auditing routines) for use by the broader audit team. - Collaborate with teammates to embed these tools into day‑to‑day audit work, provide training and documentation, and actively drive adoption across the function. - Leverage Workday's technology platforms and applications, including LLM‑based and other AI‑enabled tools, to improve audit efficiency, coverage, and insight. - Ensure quality and consistency of audit work in line with departmental and professional standards, and continuously seek opportunities to improve audit processes and methodologies. - Develop and maintain strong working relationships with teammates and management, building a solid understanding of the business and ensuring audit client satisfaction. - Continuously develop and expand knowledge of the audit profession, emerging technologies, AI and security trends, and Workday products through self‑study, research, and continuing education. About You Basic Qualifications - 5+ years of experience in technology audit, information security, or a related field. - 2+ years of experience with public and/or private cloud and software‑defined infrastructure environments, or equivalent. - 2+ years of experience in diverse technology environments (e.g., operating systems, networks, third‑party cloud‑based applications and platforms). - 2+ years of experience with technology operational processes (e.g., software development lifecycle, system integration and monitoring, data protection, identity and access management). - Hands‑on experience using AI tools or AI‑enabled workflows to improve audit processes and testing techniques, automate tasks, enhance data analysis, or streamline systems. - Demonstrated experience creatively advancing AI‑ or analytics-driven audit techniques and methodologies for the audit team. - Experience assessing emerging risks related to generative AI, machine‑learning models, automated decisioning, and AI‑enabled third‑party services. Other Qualifications - Experience in designing and implementing systems. - Experience with end‑to‑end audit delivery: planning, execution, and reporting, including integrated audits that address both operational and technology objectives. - Strong curiosity about new tools and technologies, with a bias toward experimentation, learning by doing, and sharing what you learn. - Ability to navigate ambiguity, manage multiple projects simultaneously, and take ownership to deliver on commitments. - A collaborative mindset: you build solutions others can use, share knowledge openly, and coach teammates, rather than keeping tools to yourself. - Strong written and verbal communication skills, including experience preparing workpapers, audit reports, and presentations. - Solid understanding of IIA Professional Practices and ISACA Technology Audit Standards. - Bachelor's degree or equivalent in technology or a related field. - Applicable certifications in technology, security, risk management, and/or auditing (e.g., CISSP, CISA) preferred. Workday Pay Transparency Statement The annualized base salary ranges for the primary location and any additional locations are listed below. Workday pay ranges vary based on work location. As a part of the total compensation package, this role may be eligible for the Workday Bonus Plan or a role-specific commission/bonus, as well as annual refresh stock grants. Recruiters can share more detail during the hiring process. Each candidate's compensation offer will be based on multiple factors including, but not limited to, geography, experience, skills, job duties, and business need, among other things. Primary Location: USA.CA.Pleasanton Primary Location Base Pay Range: $154,800 USD - $232,200 USD Additional US Location(s) Base Pay Range: $130,700 USD - $232,200 USD Our Approach to Flexible Work With Flex Work, we're combining the best of both worlds: in-person time and remote. Our approach enables our teams to deepen connections, maintain a strong community, and do their best work. We know that flexibility can take shape in many ways, so rather than a number of required days in-office each week, we simply spend at least half (50%) of our time each quarter in the office or in the field with our customers, prospects, and partners (depending on role). This means you'll have the freedom to create a flexible schedule that caters to your business, team, and personal needs, while being intentional to make the most of time spent together. Those in our remote "home office" roles also have the opportunity to come together in our offices for important moments that matter.

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. • Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. • Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. • Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs. • Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.