Role Description We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. - Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. - Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. - Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. - Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. - Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. - Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. - Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. - Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. - Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. - Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and health payment policy language. Qualifications - 8-12 years of experience overall. - Expert-level coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines. - Deep understanding of outpatient claims coding and auditing. - Self-motivated and able to work independently in a remote environment while maintaining high performance. - Expertise in outpatient and professional coding audits to ensure accurate code assignment and compliant reimbursement. - Exceptional time management, problem-solving, and analytical skills. - Passion for auditing and a commitment to teamwork, collaboration, and continuous learning. - Possess the CCS (Certified Coding Specialist) or CPC (Certified Professional Coder) credentials. - Superior knowledge of HCPCS, CPT, ICD-10-CM/PCS coding, and US healthcare payment methodologies for Commercial, Marketplace, Medicare, and Medicaid. - Experience with coding ambulatory surgery clinic claims and hospital observation claims to include injection and infusion claims. - Experience auditing high-cost drug and/or Durable Medical Equipment claims. - Completion of a bachelor's degree. - Excellent written and verbal English communication skills, strong analytical skills, and attention to detail. Requirements - Experience using CMS NCDs/LCDs and clinical criteria guidelines (nice-to-have). - RHIA or RHIT credential (nice-to-have). - Experience working in a start-up or high-growth company environment, demonstrating agility and adaptability (nice-to-have). - Familiarity with working with a diverse, global team of talent (nice-to-have). - Excellent computer skills and familiarity with a Mac (nice-to-have). - Ability to commute/relocate to Nacharam, Hyderabad, Telangana (Preferred). Interview Process - Connect with Talent Acquisition. - Meet with the Hiring Manager. - Behavioral Interview(s). - Case Study. - Interview with Senior Leadership.

Role Description The Investigator/Auditor for Privacy & Civil Rights is an ideal opportunity at MultiCare, working directly with compliance and business leadership to assure compliance with patient-related federal and state privacy and/or discrimination. In this position, you will plan, execute and manage a variety of regulatory, investigative and auditing based projects. Responsibilities - You will manage the investigation and remediation of any suspected incidents of discrimination. - You will research and assist on Federal and State regulatory requests or issues of non-compliance. - You will participate in OCR and other regulatory audits, meetings and initiatives. - You will facilitate tracking, resolution and response of any OCR, DOH, or DOJ requests, inquiries or Joint Commission improvement/corrective action plan. Qualifications - Bachelor's degree in computer sciences, social sciences, legal, business, or clinical field. - Master's Degree preferred. - An Associate Compliance Professional or Certified. - Minimum five (5) years of healthcare experience required. - Minimum three (3) years of investigation, compliance or legal experience working directly with state & federal regulatory agencies on civil rights issues or certification as an ADA Coordinator OR HIPAA compliance or legal experience working directly with state & federal regulatory agency. Benefits - Rooted in the local community, partnering with patients, families and neighbors across the Pacific Northwest for more than 140 years. - Competitive tuition assistance, award-winning residencies, fellowships and career development to invest in you. - Generous PTO, Code Lavender and Employee Assistance Programs to help you maintain balance and feel cared in your work and life. - Respect, integrity, kindness and collaboration guide how we care for patients, communities and each other. - Resource Groups and outreach programs help ensure every team member feels safe, seen, heard and valued. - Work and live where natural beauty, adventure and strong community connections are part of everyday life. - Comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off. - Pay scale is $82,888.00 - $119,288.00 USD, influenced by factors specific to applicants.

• Evaluate the design and effectiveness of technology controls • Identify risks and work collaboratively with business and technology stakeholders • Perform IT audits and risk assessments across various areas • Conduct walkthroughs of IT processes and systems to identify key risks, controls, and opportunities for improvement • Assess compliance with organizational policies, regulatory requirements, and industry frameworks • Participate in cybersecurity assessments and reviews • Support enterprise risk management activities by identifying emerging technology and cybersecurity risks • Prepare clear, concise, and well-documented audit workpapers, reports, and presentations

• Audits Inpatient DRG Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Inpatient DRG claims • 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 Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters • Meets or Exceeds Standards/Guidelines for Productivity: Maintains production goals set by the audit operations management team • Meets or Exceeds Standards/Guidelines for Accuracy and Quality: Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)