• Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy, CPT, HCPCS, and ICD-10 coding compliance, Modifier usage, Workers’ compensation billing rules and state-specific fee schedules, Claim submission accuracy and clean claim rates, Payment posting and adjustment accuracy, AR follow-up effectiveness and denial resolution workflows • Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance • Denial & Revenue leakage analysis: Analyze denial trends across WC, Medicare, and commercial payers, Identify root causes of denials and recommend corrective actions, Quantify revenue impact from: Coding errors, Missed charges, Underpayments, Inefficient workflows • Ensure adherence to: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, State Workers’ Compensation regulations, Documentation standards for pain management procedures • Support internal and external audit readiness (RAC, MAC, payer audits). • Reporting & KPI development through audit dashboard Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements • Partner with all BHC teams to develop and deliver targeted education based on audit findings. • Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency • Establish and maintain quality assurance programs across RCM functions • Perform routine QA reviews of staff productivity and accuracy • Recommend automation opportunities and system enhancements • Assumes other responsibilities as appropriate to the position and organizational needs

• This is your opportunity to be involved in a growing and high paced role. • The need for audits of Managing General Agents (MGAs), Third Party Administrators (TPAs), and those with delegated authority (ability to write insurance business) allows you to oversee multiple audit engagements at the same time; adding value in every step. • Our auditors act as individual project leaders where they develop and communicate workplans to team members. • You would be allocating responsibilities while simultaneously completing your own delegated tasks to ensure the successful and timely completion of your audits. • By communicating effectively with both internal and external stakeholders you are also able to be the face of Pro. • Whether working closely with audit operations (administrators & peer review), reviewing pre-audit questionnaires (PAQs), responding to documentation, or diving into audit interviews, our auditors function with a level of enthusiasm and professionalism. • You are a trusted subjected matter expert with the ability to write detailed reports and identify significant issues. • Our auditors are seen as partners to our client customers. • We are more than problem announcers and work closely to help solve and establish work and training plans to ensure compliance.

Role Description Zur Verstärkung unseres Teams suchen wir Auditoren (m/w/d) im Raum Nordrhein-Westfalen zur Durchführung von Audits. - Durchführung von Evaluationen und Audits bei Bildungsträgern - Bewertung von Maßnahmenzulassungen - Prüfung von Maßnahmen- und Trägerunterlagen im Rahmen von Zulassungsverfahren - Dokumentation von Audit- und Evaluationsberichten - Erstellung fundierter Prüfbewertungen zur Vorlage in unserem internen Entscheidungsprozess - Kommunikation mit Trägern zur Klärung von Rückfragen oder zur Nachforderung fehlender Inhalte - Zusammenarbeit mit der Zertifizierungsstelle im Rahmen der Zertifizierungsentscheidungen - Fachlicher Input zur Weiterentwicklung unserer Prüfsystematik - Optionale Beteiligung an Sonderfällen, Stellungnahmen oder Widerspruchsverfahren Qualifications - Analytisches, strukturiertes und verantwortungsbewusstes Arbeiten – sowohl eigenständig als auch im Team - Kommunikationsstärke, Teamfähigkeit und diplomatisches Geschick - Sicherer Umgang mit digitalen Anwendungen (MS Office, CRM, Standardsoftware) - Sehr gute schriftliche Ausdrucksfähigkeit in Deutsch - Pädagogischer, verwaltungstechnischer oder betriebswirtschaftlicher Hintergrund von Vorteil Requirements - Mindestens 3 Jahre Berufspraxis bei einem zugelassenen Träger nach AZAV, idealerweise in verantwortlicher Rolle (z. B. als Maßnahmemanager:in, Standortleitung, QM-Verantwortliche:r o. ä.) - Alternativ Erfahrung bei einer anderen fachkundigen Stelle - Fundiertes Wissen über das SGB III, die AZAV sowie operative Abläufe in Trägerorganisationen Benefits - Anspruchsvolles Aufgabenfeld mit hohem fachlichem Niveau – ohne Verwaltungsballast - Mitarbeit in einem fachlich anspruchsvollen und dynamischen Umfeld - Zusammenarbeit mit Expert:innen, die die Branche verstehen und wertschätzen - Strukturierte Einarbeitung und Zugang zu interner Fachdokumentation - Freiraum zur fachlichen Weiterbildung und Kompetenzentwicklung - Zusammenarbeit in einem engagierten Team - Flexibles Arbeitsmodell: Remote-Work

Role Description The ASQ Certified quality auditor ensures a company's systems, processes, and products comply with industry standards and internal regulations. He/She will evaluate the overarching processes to ensure the organization consistently delivers safe, compliant, and high-quality outcomes. - Evaluating Systems: Reviewing a company's Quality Management System (QMS) to ensure policies are properly documented and followed. - Conducting Audits: Planning, executing, and reporting on internal procedures, supplier standards, and regulatory compliance (such as ISO 9001). - Identifying Non-conformities: Pointing out areas where the organization is failing to meet established benchmarks or protocols. - Recommending Improvements: Analyzing root causes of inconsistencies and suggesting actionable corrective actions. - Stakeholder Communication: Presenting findings clearly to management and ensuring all corrective measures are properly implemented and verified. Qualifications - Certification as a Quality Auditor (CQA) - Minimum of 3 years of experience in a quality control role - Excellent attention to detail and problem-solving skills - Excellent communication and interpersonal skills - Ability to work independently and as part of a team - Familiarity with ISO 9001, or similar quality management standards - Experience with government contract is preferred.