Auditor Remote Jobs in Hawaii (US)
This page tracks remote auditor openings that are location-eligible for Hawaii.
This page tracks remote auditor openings that are location-eligible for Hawaii.
Open jobs
966
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$30 - $85,000
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966 Jobs
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• Conduct monthly and quarterly quality assessments of individual codes • Provide guidance and education to coding associates and leaders on coding guidelines • Perform quality assurance follow-up reviews • Serve as a subject matter expert for professional fee coding • Monitor and audit inpatient and outpatient accounts • Create presentations and educational materials for coding staff • Assist operational coding team with initial coding and denials • Train new and existing staff • Develop training materials and coding aids • Report audit findings to coding management and leadership
Role Description We currently have an exciting remote opportunity for an experienced DRG Validator. This position offers the best of both worlds: the challenge and reward of using and growing your coding expertise, combined with the flexibility and convenience of working from home. The DRG Validator is responsible for reviewing inpatient medical records to ensure the accuracy and integrity of DRG assignments, clinical documentation, and coding. This role supports compliance with regulatory guidelines and optimizes appropriate reimbursement. Key Responsibilities - Review inpatient medical records to validate the accuracy of assigned DRGs - Ensure compliance with ICD-10-CM/PCS coding guidelines and CMS regulations - Identify discrepancies in coding or documentation and recommend corrections - Collaborate with coding teams, CDI specialists, and physicians to clarify documentation - Conduct audits to detect undercoding, overcoding, or billing errors - Provide feedback and education to coding staff on DRG optimization and compliance - Maintain productivity and quality standards for case reviews Qualifications - Certified coding credential (RHIA, RHIT, CCS) - Strong knowledge of ICD-10-CM/PCS coding systems - Understanding of MS-DRG/APR-DRG methodologies - Minimum of 3 years’ experience in inpatient coding and auditing or DRG validation - Strong technical skills, including experience with VPNs, multi-factor authentication, and video conferencing tools - Proficiency in Microsoft Office, particularly Outlook (email and calendar) and Excel - A consistent, reliable work schedule and punctual attendance Benefits - Dynamic work environment - Career growth and development - Strong leadership - TOP PAY Contact Information Ready to take the next step in your career? - 📞 Call us at 800.526.0594 - 📧 Email: HR@uasisolutions.com - 🌐 Visit: www.uasisolutions.com
• Analyzes and Audits Claims • Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities • Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions • Performs work independently • 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 • Identifies New Claim Types • Suggests and develops high quality, high value concepts and or process improvement tools
• Audits Outpatient and Specialty Claims • Utilizes medical chart coding principles and client specific guidelines • Performs work independently, reviews and interprets medical records • Utilizes advanced proficiency, Cotiviti encoder and audit tools • Maintains production goals, accuracy and quality standards • Identifies potential claims outside of concept for additional recoveries • Suggests, develops and implements new ideas for audit production and client satisfaction
Role Description UPMC Health Plan has an exciting opportunity for a Clinical Auditor/Analyst position in the Fraud, Waste & Abuse department. This is a full-time position working Monday through Friday daylight hours and will be a remote position. The Clinical Auditor/Analyst is an integral part of the Special Investigations Unit (SIU) and is responsible for conducting clinical audits and reviews regarding the analysis of care and services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization. The Clinical Auditor/Analyst creates, maintains and analyzes auditing reports related to their assigned work plan and communicates the results with management. Other responsibilities include but are not limited to: - Analysis of controlled substance prescribing and utilization to identify potential clinical care issues. - Prepayment review of claims and unlisted codes. - Claims analysis and the use of fraud and abuse detection software tools. - Collaboration with appropriate Health Plan departments including Quality Improvement, Legal, and Medical Management. - Interaction with providers, law enforcement, and/or regulatory entities. Responsibilities: - Respond to fraud, waste, and abuse referrals and/or complete data analysis and related audits as assigned. - Utilize fraud detection software to assess and monitor for potential FWA. - Review and analyze claims, medical records and associated processes related to the appropriateness of coding, clinical care, documentation, and health plan business rules. - Provide a clinical opinion for special projects or various issues including appropriate utilization of controlled substances, prescribing of controlled substances, or medically appropriate services. - Query medical and/or pharmacy claims and conduct a risk assessment by performing data analysis and applying applicable coding guidelines, Health Plan policies, and any applicable National Coverage Determination (NCD) or Local Coverage Determination (LCD). - Evaluate referrals from Pharmacy Benefit Manager (PBM) by analyzing medical and pharmacy claims and associated clinical documentation in HealthPlaNET, Mars, Epic and/or Cerner. - Complete audits by utilizing standard coding guidelines and principles and coding clinics to verify that the appropriate CPT codes/DRGs were assigned and supported in the medical record documentation. - Attend in person or virtual recipient restriction hearings. - Review Medical Pended Queue claims to understand and resolve claim referral issues through research and interaction with other Health Plan Departments including Medical Management, Medical Directors, various committees, and other appropriate Health Plan departments. - Assist in the development of new policies concerning future Health Plan payment of identified issues as necessary. - Assess, investigate and resolve low to intermediate issues. - Write concise written reports including statistical data for communication to other areas of UPMC Health Plan and to communicate with department heads for identification of various problem issues, how they affect the Health Plan, and to make recommendations for resolution of the issue. - Identify error trends to determine appropriate training needs and suggest modifications to company policies and procedures. - Conduct provider education, as necessary, regarding audit results. - Communicate effectively with Medical Directors and ancillary departments as necessary to address issues and concerns. - Understand customers including internal Health Plan Departments (i.e. Claims staff, Customer Service, Marketing, etc.) and external customers (i.e. Health System Internal Audit, Client Audit teams) to understand issues, identify solutions and facilitate resolution. - Serve as an SIU representative at internal and external meetings, document and present findings to SIU Staff and document as appropriate in the SIU FWA Case Management Database. - Assist in the development and revision of SIU policies and procedures. - Identify trends for improvements internally, such as claims payment, to determine appropriate training needs and suggest modification to company policies and procedures. - Participate in training programs to develop a thorough understanding of the materials presented. - Obtain CPE or CEUs to maintain nursing license, and/or professional designations. - Design and maintain reports, auditing tools and related documentation. - Maintain or exceed designated quality and production goals. - Maintain employee/insured confidentiality and adhere to HIPAA regulations. Qualifications - Registered Nurse (RN). - Five years of clinical experience. - Two years of fraud & abuse, auditing, case management, quality review or chart auditing experience required. - Ability to analyze data, maintain designated production standards, and organize multiple projects and tasks. - In-depth knowledge of medical terminology, ICD-10 and CPT-4 coding. - Knowledge of health insurance products and various lines of business. - Detail-oriented individual with excellent organizational skills. - Keyboard dexterity and accuracy. - High level of oral and written communication skills. - Proficiency with Microsoft Office products (Excel, Access, OneDrive, OneNote and Word). Requirements - AAPC or AHIMA Certified (CPC, CPMA, CIC, CCA, CCS, CCS-P) or AHFI designation preferred. - Registered Nurse (RN). - Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.
We’re one of the fastest-growing civil defense firms in the country—known for breaking the mold of the traditional law firm. Our dynamic, diverse team of trial attorneys delivers exceptional results, from landmark cases to numerous defense verdicts across the nation. We invest in our people with specialized training in our proven defense methods, clear paths to leadership, and robust professional development.
Role Description We're looking for a billing compliance professional who has been in the weeds; someone who has audited timekeeper entries line by line, pushed back on attorneys when entries didn't hold up, and written appeals that resulted in successful resolutions. You know your UTBMS codes. You know when a narrative is going to get cut before it ever reaches the carrier. And when the billing guidelines don't have a clear answer, you make a sound judgment call, in alignment with the spirit of carrier guidelines, and own it. This is a high-volume role with real variety, steady audit work, alongside special projects that require you to shift gears quickly, reprioritize, and perform at a high level under pressure. You'll work within a collaborative, fully remote team that communicates directly, respects each other's expertise, and expects everyone to bring their best. If you've spent years building expertise in this niche and you're looking for a team that actually values it, this is for you. This position reports to the Director of Quality Assurance and the Head of Legal Operations, and collaborates closely with the Billing Department. This is a fully remote position. Our entire team works 100% remotely, and we are built to operate that way with strong communication, clear expectations, and mutual accountability. For candidates located near one of our office locations, optional hybrid arrangements are available but never required. The right candidate is someone who takes ownership, communicates proactively, and thrives with autonomy. Responsibilities - Conduct front-end pre-bill audits for insurance defense matters before invoices are submitted to carriers. - Perform line-by-line invoice review to verify accuracy, reasonableness, and compliance with carrier billing guidelines and UTBMS task codes. - Identify billing discrepancies based on carrier requirements, industry standards, and litigation practices and make corrections before submission. - Communicate directly with attorneys, paralegals, and billing staff to resolve non-compliant entries, including navigating pushback with professionalism and persistence. - Prepare, submit, and track formal billing appeals; coordinate with the billing department to adjust invoices following appeal outcomes. - Build and analyze compliance reports in Excel to identify timekeeper performance trends and systemic billing issues. - Escalate recurring billing trends or compliance risks to management for resolution. - Manage the Billing Compliance inbox, triaging and prioritizing incoming requests. - Contribute to special projects including large-scale compliance initiatives and carrier-specific audit reviews as assigned. - Exercise sound independent judgment when billing guidelines are ambiguous or silent, acting in alignment with the spirit of carrier guidelines, and communicate your rationale clearly. Qualifications - Minimum 3–5 years of direct front-end bill review experience in an insurance defense law firm, or equivalent experience with an e-billing platform provider (e.g., CounselLink, Bottomline, Legal Tracker) supporting insurance defense billing compliance, timekeeping oversight, or litigation defense matters. - Proven ability to audit billable hours for attorneys, paralegals, and other timekeepers prior to carrier submission. - Strong knowledge of UTBMS task codes, carrier billing rules, and common rejection reasons. - Demonstrated experience preparing and submitting successful billing appeals including strong written communication skills and the ability to construct persuasive, well-documented appeal narratives. - Advanced proficiency in Microsoft Excel, including pivot tables, formulas, and building custom reports to identify trends and support audit findings. Excel fluency is essential; we will train on internal processes, but this skill must come with you. - High comfort operating in a high-volume billing environment with competing deadlines, shifting priorities, and periodic large-scale special projects. - Demonstrated ability to exercise sound independent judgment when billing guidelines are ambiguous or silent, acting in alignment with the spirit of carrier guidelines. - Strong written and verbal communication skills with a professional, direct style. Requirements - Prior experience as a timekeeper (paralegal, legal assistant, or similar role) in a litigation environment, candidates who have billed time themselves bring a practical understanding of how entries are constructed and where compliance issues originate. - Direct litigation experience in an insurance defense, civil litigation, or related legal setting. - Familiarity with carrier billing portals and billing guidelines across multiple major insurance carriers (P&C, commercial, and specialty lines). - Experience with e-billing platforms such as CounselLink, Bottomline/Legal eXchange, Legal Tracker, BillBlast, TyMetrix 360, or similar. - Familiarity with billing guidelines across multiple insurance carriers. - Bachelor's degree or equivalent combination of education and direct experience. Benefits - The hourly pay range of $30-37/hour, depending on experience. - Overtime paid at 1.5× the regular hourly rate, as needed. - Comprehensive benefits coverage offered, including plans available at zero employee cost (average annual employee contribution for health/vision/dental coverage is $700-1,700). - Employee Assistance Program through HealthAdvocate. - Employees benefit from a 401(k) program that includes a 100% match on the first 3% contributed and a 50% match on the following 4-5%. - Vacation time is accrued annually at the employee’s base rate. - Paid parental leave at base pay. - Employees receive a monthly technology reimbursement of $60. - 37.5-hour standard workweek designed to promote balance and prevent burnout. - Educational reimbursement program for non-attorney eligible team members (up to $3,500 per calendar year). - Internal diversity and inclusion programs, such as the Women’s Initiative and Young Professionals Initiative. - Firm-wide charitable giving program. - Numerous social and off-site events each year to enrich your relationships with your colleagues.
NSF International, formerly known as the National Sanitation Foundation, is an award-winning, nonprofit, non-governmental organization headquartered in Ann Arbor, Michigan. Founded
Role Description We are looking to expand our team with the addition of a Senior Aerospace Auditor - Independent Contractor to conduct 3rd party audits for NSF's aerospace clients. The Independent Contractor Auditor will be responsible for: - Communicating effectively with external clients - Communicating effectively with internal Account Managers Qualifications - Experience in aerospace auditing - Strong communication skills - Ability to work independently Requirements - Relevant certifications in aerospace auditing - Proven track record in conducting audits Benefits - Flexible working hours - Opportunity to work with a diverse team - Impactful work that contributes to global health and safety
The easier way to employ globally. Remote builds belonging for your team with payroll, benefits, & compliance solutions.
Role Description The IT Internal Auditor audits information systems, platforms, and operating procedures in accordance with established corporate standards for efficiency, accuracy, and security. This role also evaluates IT infrastructure in terms of risk to the organization and establishes controls to mitigate loss, determines and recommends improvements in current risk management controls, and is responsible for implementation of system changes or upgrades at the Corporate office. Essential Duties and Responsibilities - Prepares and follows audit programs to conduct audits in accordance with the annual audit plan. - Responsible for developing test procedures for IT general controls, automated business process controls, and key reports. - Performs technical assessments/analyses of systems, general controls, and application systems using risk assessment techniques. - Identifies risk factors of automated functions and controls, related manual procedures, and general control environment. - Responsible for the overall preparation, review, and execution of organization-wide IT Sarbanes Oxley (SOX) control tests. - Maintains and keeps up to date SOX testing tools with accurate test procedures, results of test work, evidence, conclusions, etc. - Assists with development of SOX content and general controls. - Analyzes data obtained for evidence of deficiencies in controls, duplication of efforts, extravagance, fraud, or lack of compliance. - Presents audit issues to Internal Audit Management for the development of reports and recommendations. - Performs observations of departmental procedures to ensure compliance and operational efficiencies. - Completes audit files with working papers referenced to the audit programs. - Liaises with external auditors to communicate information and resolve problems. - Maintains audit files, ensuring they contain planning memos, programs, and reports. - Assists in planning the theory and scope of audits and related audit programs. - Enthusiastically supports, actively promotes, and demonstrates superior customer service. - Participates in meetings and training as required. - Maintains complete confidentiality of all company information at all times. - Ensures that behavior and appearance are in compliance with established standards. - Maintains a professional work environment with management and staff. - Performs all job duties in a safe and responsible manner. - Responsible for ensuring compliance with all regulatory compliance within area of responsibility. Qualifications - Must be at least 21 years of age. - Bachelor’s degree (B.A./B.S.) from a four-year college or university in Finance, Accounting, or related field required. - CPA, CIA, CITP, or CISA certification strongly desired. - Two or more years’ experience with SOX 404 compliance and internal controls evaluation. - Familiarity with PCI Data Security Standards version 3.1 required. - Minimum of three years of combined technology and Internal Audit experience and/or training. - Familiarity with standards, concepts, practices, and procedures with Sarbanes-Oxley Act preferred. - Must be able to travel up to 30%. - Advanced skills in Microsoft applications (Word, Excel, PowerPoint, and Outlook). - Excellent verbal and written communication skills. - Ability to add, subtract, multiply, and divide in all units of measure. - Ability to effectively present information and respond to questions from groups. - Ability to write reports, business correspondence, and procedural manuals. - Must have the ability to interact with guests, staff, and colleagues diplomatically. - Must be able to maintain confidentiality and a high level of professionalism at all times. Starting Salary $85,000
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
Role Description The Coding Auditor will be responsible for inpatient and outpatient coding and auditing for various specialties. This role will also be responsible for preparing and presenting audit results. - Perform coding audits and compliance audits for providers, including physicians and mid-level providers. - Prepare reports of audits and present audits to internal and external parties as needed. - Complete accurate application of appropriate coding and documentation guidelines, including but not limited to: - E&M and surgery documentation guidelines - CCI guidelines - CPT/HCPCS coding guidelines - Specialty association guidance - Provide physician education when necessary, including audit findings or edit and denial trending. - Complete coding audits for our copartners’ coding WQ. - Work with any offsite auditors. - Evaluate and report on the overall quality of physician documentation that supports selected codes, specifically regarding medical necessity. - Adhere to local and national coverage determinations, CCI, and payer specific editing rules. - Ensure appropriate documentation and coding of split/shared services, teaching physician guidelines, and any client specific quality assessment programs. - Compile, trend, analyze, and report on all findings that do not meet the guidelines listed above. - Maintain a professional attitude. - Other duties as assigned by the management team. - Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Understand and comply with Information Security and HIPAA policies and procedures at all times. - Limit viewing of PHI to the absolute minimum necessary to perform assigned duties. Qualifications - High School diploma or equivalent required. - CPC or CCS coding certification required from AHIMA or AAPC. - Minimum 5 years of coding experience and minimum 2 years auditing experience in a multi-specialty setting. - Must be able to use job-related software. - Self-starter with ability to work independently. - Proficiency in Microsoft Office Suite. - Strong interpersonal skills, ability to communicate well at all levels of the organization. - Strong problem solving and creative skills, ability to exercise sound judgment and make decisions based on accurate and timely analyses. - High level of integrity and dependability with a strong sense of urgency and results oriented. - Excellent written and verbal communication skills required. - Gracious and welcoming personality for customer service interaction. Requirements - Must possess a smart-phone or electronic device capable of downloading applications for multifactor authentication and security purposes. Working Conditions - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals, and telephones; extend arms; kneel; talk and hear. - The employee must be able to follow directions, collaborate with others, and handle stress. - The noise level in the work environment is usually minimal.
Baptist Health South Florida, a faith-based, nonprofit healthcare organization, is the largest of its kind in the area and widely known for providing exceptional care and services
Role Description The Nurse Auditor is an expert clinician in the related specialty practice that combines clinical practice with education and leadership. Responsibilities include: - Overseeing and performing the concurrent, pre-bill and assisting with retrospective audits of billed charges against medical records to identify missing revenue. - Identifying opportunities related to charging properly and determining the root cause. - Working with the leadership team to develop appropriate and standard charging and documentation practices. - Participating in the annual departmental charge master review. - Assisting in the training of clinical staff on changes in the chargemaster. Estimated salary range for this position is $80,516.80 - $107,087.34 / year depending on experience. Qualifications - Degrees: Bachelors. - Licenses & Certifications: Registered Nurse. - Minimum 3 years of clinical experience. - Procedural coding, billing and audit experience required. - Extensive knowledge of laws, regulations and rules applicable to billing government payers is helpful. - Demonstrated ability to be self-directed with excellent organization, analytical and interpersonal skills. - Excellent oral and written communications skills. - Strong attention to detail. - National certification in related department specialty preferred. - Minimum Required Experience: 4 Years. Benefits - Career growth and development opportunities, with clear pathways and ongoing support. - Comprehensive health and wellness resources that go beyond traditional benefits. - A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs. - Tuition reimbursement to support continued learning and advancement. - And so much more. Company Description Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels our commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in.
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