Remote Auditor Jobs in the US

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RN MSK Preservice Review Nurse

UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Auditor9 hours ago

Full Time Remote Mid Level

Company Site

Role Description As a member of the Optum team, you will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. - Review of Musculoskeletal (MSK) care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria. - Review documentation submitted to support the medical necessity of the request. - Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. - Maintain contact with all parties involved in case necessary for case management for the client. - Adhere to all documentation and performance guidelines. - Assess and interpret customer needs and requirements. - Identify solutions to nonstandard requests and problems. - Work with minimal guidance; seek guidance on only the most complex tasks. Qualifications - Associates, Bachelors or equivalent in Nursing. - Current and active unrestricted Nursing License or certification. - 3+ years of experience, with 1+ years of Musculoskeletal, or Pre-Authorization related experience. - Knowledge of the clinical criteria (e.g. CMS, InterQual, etc.). - Proficiency in operating computer applications. - Willing to work an occasional Saturday if requested by the business. Requirements - Medicare Pre-Authorization experience (preferred). - Managed Care experience (preferred). - Proven excellent interpersonal skills (preferred). - Proven excellent verbal and written communications skills (preferred). Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. 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.

View details: RN MSK Preservice Review Nurse

United States

$29 - $52 / hour

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Claims Auditor

PRO IS Inc

Pro IS, Inc. is a subsidiary of Pro Global Insurance Solutions (www.pro-global.com). Pro is a global service provider and consulting company focused solely on the insurance and reinsurance industries. We are based in financial centers around the world so we can provide our clients with cost efficient, round-the-clock services. We are continuing to build our presence in the US. If you have the skills mentioned above and are looking to join a growing business, then submit your resume and one of the recruitment team will be in touch. PRO IS an Equal Opportunity Employer.

Auditor10 hours ago

Full Time Remote Mid Level

Role Description PRO IS, Inc. currently has an exciting Claims Auditor position available within our audit team. This client-facing role would suit experienced, highly motivated candidates who are able to handle multiple demands with a sense of urgency, drive, and energy while growing and maintaining client relationships. This role is fully remote within the USA but it may include some travel within the USA. Main Responsibilities - Manage multiple audit engagements and lifecycles at one time: overseeing the entire audit process including compiling data from third-party administrator on claims handling structure and requesting information in preparation for the audit. - Audit Third-Party Administrators and Client Claims Teams to ensure adherence to contractual agreements, SLAs, industry standards, and regulatory requirements. Audit Specific Work - Review pre audit questionnaire (PAQ) responses and necessary documentation; drafting follow-up questions and inquiries as needed. - Manage communication, preparatory, onsite/remote, wrap up, meeting, and post audit/reporting activities. - Analyze claims data to identify trends, exposures, and comparing to best practices. - Evaluate any liability or coverage decisions to evidence appropriate claims handling decisions. - Write professional, detailed reports and appendices; if required or if significant issues identified, prepare the initial summary assessment of findings for client. - Liaise with Audit Administrator regarding audit preparations and MGA/Coverholder/TPA readiness. - Refer to Peer Reviewer before releasing to client. Qualifications - Minimum of 5 years insurance claims experience is required with a demonstrable track record of auditing and business and client relationship development. - Bachelor’s degree in business administration or similar field. - Must have successfully completed one or more of the educational programs through the Insurance Institute of America or the Professional Insurance Agents, such as, Chartered Property Casualty Underwriter (CPCU), Program in General Insurance, Associate in Claims (AIC), etc. - Equivalent education, work experience, knowledge, and skills may qualify. - Excellent working knowledge of insurance claims; having experience reviewing claims being submitted to our clients. - Highly structured and conceptual mindset coupled with strong quantitative and analytical problem-solving aptitude. - Excellent written and oral communication skills. - Detail oriented, with excellent organizational and planning skills. - Ability to work independently, with a team, and with initiative is essential. - Ability to travel within the USA up to 10% of the time. Company Description PRO IS, Inc. is a subsidiary of Pro Global Insurance Solutions (www.pro-global.com). Pro Global is a global service provider and consulting company focused solely on the insurance and reinsurance industries. We are based in financial centers around the world so we can provide our clients with cost efficient, round-the-clock services. Our insurance and reinsurance professionals work on projects in a variety of specialties such as re/insurance technical accounting, claims management, actuarial support, audits, project and change management, process improvements, and run-off portfolio management. If you have the skills mentioned above and are looking to join a growing team, please click to apply and the recruitment team will be in touch. Pro does not provide sponsorships for visas, either at the time of hire or going forward. You must be fully authorized to work for any US employer. No agencies please.

View details: Claims Auditor

United States

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Coding Auditor – Hospital Inpatient Compliance Edits

Franciscan Health

Based in Indiana, Franciscan Health is one of the Midwest's largest Catholic healthcare systems. Founded in 1876, the nonprofit organization was named one of Tr

Auditor12 hours ago

Part Time Remote Senior

Company Site

• Collaborates with coding leadership and peers in the development and/or implementation of audit/monitoring plans. • Evaluates prebill hospital inpatient coding compliance edits to ensure compliance with payer reimbursement methodologies and official coding guidelines. • Summarizes quality review results for Coding Managers, Supervisors, Coding Educator, and coding staff. • Participates in team meetings with coding personnel when necessary to discuss coding findings. • Act as a subject matter expert regarding payer reimbursement methodologies and official coding guidelines. • Provides details specific to audit trends to the Coding Educator for preparation of ongoing education. • Notifies coding leadership of trends and topics for education and feedback to coders, physicians, and departments.

View details: Coding Auditor – Hospital Inpatient Compliance Edits

United States

$48.8K - $72.7K / year

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Principal Investigator in Archaeology

Atwell, LLC

Atwell, LLC is a bold leader in the consulting, engineering, and construction services industry, delivering a broad range of creative solutions to clients in the real estate & land development, and energy markets. We have a strong national presence and a diverse, award-winning project portfolio. Atwell is a privately owned company, with 2,000+ passionate team members across 70+ locations and growing! Ten consecutive years in a row as a “Best Place to Work” by Zweig Group (#11) Recognized as #70 in the ENR Top 500 Design Firms, ranked in every region Recognized in Crain's “Fast 50” as one of the fastest-growing companies (#14) Recognized as the 2025 ENR Design Firm of the year for the Southeastern US

Auditor12 hours ago

Full Time Remote LeadTeam 1,001-5,000

Role Description Atwell, LLC is seeking a full-time Archaeological Principal Investigator to conduct, oversee, and direct field investigations, implementing procedures established by our clients and our firm. Projects range from small, self-performed field investigations to supervising field crews. The Principal Investigator will be responsible for performing tasks associated with archaeological investigations and surveys within the archaeological project area; completing project documentation and reports; as well as coordinating fieldwork, scheduling, reporting, and any other project needs with leaders and clients. A successful candidate will be self-motivated, have time management skills, and have a working knowledge of both state and federal regulations. This position will be remote and can report to any of our 76 offices as needed. - Completing initial project reviews for our clients and project managers. - Performing pedestrian walkover surveys, controlled surface surveys, and hand excavation (shovel testing), often times solo. - Maintaining field records and paperwork. - Directing archaeological site documentation. - During pedestrian survey, determining types of appropriate survey coverage within the project area. - Ensuring accurate digital recordation of survey data. - Digital recordation and mapping of archaeological sites using an established data dictionary. - Digital data quality control. - Authoring reports, agency letters, Section 106 of the National Historic Preservation Act request forms, and other documents. - Overall safety of the field crew and ensuring adherence to project safety protocols. - Adhering to all of Atwell and client-directed safety policies and procedures, including the use of personal protective equipment (PPE). - Coordinate project needs between Project Managers and clients with the rest of the cultural resource group. - Communicating with clients, Project Managers, and other team members. Qualifications - Archaeology with a graduate degree in archaeology, anthropology, or related science required. - Project-specific certifications and licensure may be required, if applicable. - A graduate degree with a minimum of 3 to 5 years of experience in a similar leadership capacity conducting pedestrian survey and evaluative site testing fieldwork is preferred. - Knowledge of state-specific cultural resource guidelines is required. - Experience with leading field crews. - Working knowledge of word processing, internet browsers, photo management software, and email. - Working knowledge of federal and various state regulations as they pertain to cultural resource management. - Ability to calculate figures and amounts such as percentages, area, ratio, circumference, and volume. - Ability to apply basic mathematical concepts to practical situations. - Ability to read, analyze, and interpret general technical procedures and governmental regulations related to cultural and historic preservation. - Ability to write detailed archaeological reports and business correspondence. - Ability to define problems, collect data, establish facts, and draw valid conclusions. - Ability to interpret technical instructions and work with abstract and concrete variables. Benefits - Generous Paid Time Off. - Paid Parental Leave. - Flexible work schedules are available for some positions. - Tenure Awards — Travel Vouchers to see the world based on your travel preferences. - Competitive Compensation packages. - Annual bonuses, spot bonuses, and peer recognition awards. - 401K match - 1:1 up to 4% of compensation. - Tuition Assistance. - Student Loan Repayment. - Paid Licensing / Certification Fees and Renewals. - Financial Rewards for Obtaining Licensure. - Employee Referrals. - Annual Wellness Reimbursement for anything wellness related (Gym memberships, fitness tracker, home gym equipment, etc.). - Dependent Care Match. - Medical (BC/BS), Dental (Delta), and Vision (VSP). - Family Planning & IVF Benefits. - Pet Insurance. - Health Savings Account & Flex Spending Account options. - Employer paid LTD, STD, and life insurance. - Metlife Supplemental Benefits covering accident, hospitalization, and critical illness. - Member Assistance Program (MAP) with complimentary counseling sessions, legal benefits, financial consultations, and work/life referral services. Company Description Atwell, LLC is a bold leader in the consulting, engineering, and construction services industry, delivering a broad range of creative solutions to clients in the real estate & land development, and energy markets. We have a strong national presence and a diverse, award-winning project portfolio. Atwell is a privately owned company, with 2,000+ passionate team members across 75+ locations and growing! - Ten consecutive years in a row as a “Best Place to Work” by Zweig Group (#11). - Recognized as #70 in the ENR Top 500 Design Firms, ranked in every region. - Recognized in Crain's “Fast 50” as one of the fastest-growing companies (#14). - Recognized as the 2025 ENR Design Firm of the year for the Southeastern US.

View details: Principal Investigator in Archaeology

Worldwide

$71.5K - $88K / year

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Senior Medical Auditor

The US Oncology Network

The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

Auditor14 hours ago

Full Time Remote SeniorTeam 10,001

Role Description With general supervision of the State Reimbursement Manager, performs complete medical record chart and coding audits for medical and radiation oncology physicians, per The US Oncology Network's established guidelines. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards. Responsibilities - Performs paper and EMR chart audits for medical oncology physicians/providers in accordance with The US Oncology Network's requirements to ensure medical records are commensurate with captured charges and billing. - May use a variety of reports to accomplish tasks, such as AMA guidelines, Medicare LCD's, commercial payor billing guidelines, coding manuals, and ASTRO/ACR guidelines. - All new providers will have an E & M audit within 90 days. - Prepares a spreadsheet of findings that details discrepancies and summarizes metrics. - Identifies trends that could be perceived as non-compliance with local and federal regulatory guidelines. - Recommends procedural improvements and training opportunities to management. - Provides written audit report to supervisor for review and approval. - Reviews approved audit findings with physicians and mid-level providers to discuss recommendations and improvement opportunities; radiation audit technical findings will be forwarded to appropriate hospital contact. - Recommends and documents audit procedures, standard reports, and metrics to provide the appropriate information. - Maintains the confidentiality of medical information contained in each record. - Assists with other audits such as hospital visits, consultations, and others as assigned. - Assists with The US Oncology Network's audit and compliance or Reimbursement audits such as providing records, audit reports, and standard operating procedure manuals. Qualifications - High School diploma/ GED Required - CPC Required - Nine (9) years of billing, coding, and medical records experience required. - Completion of required The US Oncology Network's Reimbursement tutorials as required by the Compliance Department required. - Internal Billing and Coding Integrity Program certification (BCS-M) in Medical Oncology and (BCIP) in Radiation Oncology. - Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits. - Must possess a strong knowledge of current versions of ICD9, CPT4, and HCPCS. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. Work Environment The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. Benefits - M/D/V - Life Insurance - 401(k) - PTO - Paid Holidays

View details: Senior Medical Auditor

United States

$28 - $38 / hour

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Medical Auditor II

SAIF Corporation

SAIF Corporation is a not-for-profit workers' compensation insurance company dedicated to providing affordable coverage and ensuring workplace safety across the

Auditor19 hours ago

Full Time Hybrid Senior

Company Site

Title: Medical Auditor II Location: US - Oregon, Salem Hybrid Full time Job Description: Compensation Grade:&rlm;&rlm;&lrm; &lrm;21 When you hear the term auditor, do you think of mountains of paperwork and digging through files with a fine-tooth comb? As a medical auditor for SAIF, you’ll work in a computerized, fast-paced production environment to ensure payments to medical providers are accurate and timely. No reams of paper for this job. A medical auditor does more than review medical bills and ensure correct payment amounts. You’ll serve as the primary point of contact for medical providers, claims adjusters, and other parties involved in medical bill payment. You will also be explaining payment amounts, answering their questions and explaining workers compensation rules. If you like working on a team in a fast-paced environment, and you know your way around medical bills, chart notes, and coding, we invite you to apply. Please note: Flexible workers may be required to travel to SAIF’s offices in Salem, Oregon. Responsibilities: - Review automated audit results and documentation and make adjustments to audit results when necessary to reflect correct payment amounts in accordance with accepted condition, policies, guidelines, coding standards and regulations. Forward audit recommendation to claims adjuster for final review and payment determination or approve bills for payment based on claims adjuster direction, or guidelines. - Research medical audit and system issues and communicate this information with recommended actions to internal and external customers, including claims adjusters, medical providers, and MCOs. Explain pertinent laws, rules, and policies, to internal and external customers, including claims adjusters, medical providers, and MCOs and how the policies impact audit recommendations. - Recognize services requiring complex review and forward to the designated resource for resolution. - Report unusual billing patterns to supervisor for assessment, follow up and referral to the Investigations unit when applicable. - Requests refunds from providers when overpayments occur. - Process prescription drug authorizations and billings through pharmacy benefit on-line system, using knowledge of standard pharmacy codes and SAIF’s policies. Communicate with claims adjusters and pharmacies regarding issues related to processing drug prescriptions. - Explore diverse perspectives and consistently behave sensitively toward differences in cultural norms, expectations, and ways of communicating. Work effectively with others who have different perspectives, backgrounds, and/or work styles. - Continually sustain the Inclusive Leadership Competencies (ILC) through the Explorer level on an annual basis. Recommended qualifications: - Three or more years of experience processing medical insurance billings and using medical terminology, ICD-10 and CPT codes. - High school graduation or equivalent education and completion of medical terminology and ICD-10/CPT code courses. - Other combinations of skills and experience may be considered. Next step To receive consideration, please submit your resume with a cover letter by the close of this recruitment. We want your submission to count, so be sure it’s complete. If a sufficient number of qualified applications are received this recruitment may close early. Compensation & Benefits Typical hiring range:&rlm;&rlm;&lrm; &lrm;$63,835&rlm;&rlm;&lrm; &lrm;-&rlm;&rlm;&lrm; &lrm;$75,100.&rlm;&rlm;&lrm; &lrm;The pay range for this position is annually based on a full-time schedule. Actual compensation will be determined using factors such as experience, skills, training, certifications & education. SAIF provides a wide range of benefits to employees who work at least 20 hours per week, including health care, retirement savings plans, paid time off, and more. *Note that eligibility and cost of benefits can vary depending on the number of regularly scheduled hours, and job status such as regular full-time, regular part-time, seasonal, or temporary employment. Full salary range:&rlm;&rlm;&lrm;&rlm;&rlm;&lrm; &lrm;$56,325&rlm;&rlm;&lrm; &lrm;-&rlm;&rlm;&lrm; &lrm;$93,875

View details: Medical Auditor II

Oregon

$56.3K - $75.9K / year

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Internal Auditor I

Stewart Title

Auditor1 day ago

Full Time Remote Mid LevelTeam 5,001-10,000Since 1893H1B No Sponsor

Company Site LinkedIn

Role Description Provides systematic and strategic approaches related to the effectiveness of risk management control and governance processes. Examines and evaluates organization processes, reporting findings back to management regarding possible improvements and corrections. Job Responsibilities - Develop internal audit scope and audit plans - Assists in audits within the organization's internal operations as directed by leadership - Prepare and present reports that reflect audit results and document processes - Typically follows existing procedures to perform routine assignments and to solve standard problems - Analyzes basic information and standard practices to make decisions impacting work performed - Individual contributor working with direct oversight - Performs all other duties as assigned by management Qualifications - Bachelor’s degree in relevant field preferred Requirements - Typically requires 0-2 years of related work experience Benefits - Competitive benefits package - Variety of health and wellness insurance options and programs - Paid time off - 401(k) with company match - Employee stock purchase program - Employee discounts

View details: Internal Auditor I

United States

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Vehicle Inventory Representative, Auditor

CCC Intelligent Solutions

Auditor1 day ago

Part Time Remote SeniorTeam 1,001-5,000Since 1980H1B Sponsor

Company Site LinkedIn

• Complete assigned audits at automotive repair facilities in accordance with OEM and manufacturer guidelines, based on site availability and scheduling • Complete monthly vehicle inventory at dealerships by the assigned deadline, which offers flexibility to determine when work is completed • Conduct required visual inspections while accurately documenting vehicle and audit information. • Ensure timely, accurate data is submitted to support our audit programs, reporting, and automotive market valuation • Work independently while meeting quality standards and assigned deadlines

View details: Vehicle Inventory Representative, Auditor

New York

$275 / month

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Vehicle Inventory Representative, Auditor

CCC Intelligent Solutions

Auditor1 day ago

Part Time Remote SeniorTeam 1,001-5,000Since 1980H1B Sponsor

Company Site LinkedIn

View details: Vehicle Inventory Representative, Auditor

Washington

$300 / month

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Revenue Cycle Auditor, RN

Providence

Auditor1 day ago

Full Time Remote SeniorTeam 10,001+Since 1856H1B Sponsor

Company Site LinkedIn

• Providing patient focused, standardized, compliant revenue cycle support • Assisting Providence St Joseph Health in meeting financial objectives • Collaborating with Revenue Cycle Business Services team

View details: Revenue Cycle Auditor, RN

Alaska + 6 more

$35.0K - $71.5K / year

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