Auditor Remote Jobs in Tennessee (US)
This page tracks remote auditor openings that are location-eligible for Tennessee.
This page tracks remote auditor openings that are location-eligible for Tennessee.
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Role Description This position is in the Health Information Management (HIM) section at the Northern Arizona VA Medical Center. MRT (Coder) Auditor's are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. These coding practitioners analyze and abstract patients' health records and assign alpha-numeric codes for each diagnosis and procedure. Responsibilities - Utilize computer applications with varied functions to produce a wide range of reports, abstract records, and review assigned codes. - Perform audits of encounters to identify areas of noncompliance in coding. - Facilitate improved overall quality, completeness, and accuracy of coded data. - Work with staff to ensure that regulations are met or areas of weakness are identified and reported to appropriate supervisor for corrective action. - Select and assign codes from the current version of several coding systems including ICD, CPT, and/or HCPCS. - Adhere to accepted coding practices, guidelines, and conventions when choosing the most appropriate codes to ensure ethical, accurate, and complete coding. - Search the patient record to find documentation justifying code assignment based on an expanded knowledge of the organization and structure of the patient health record. - Perform audits of coded data, develop criteria, collect data, graph and analyze results, create reports, and communicate findings to appropriate leadership and groups. - Maintain statistical database(s) to track results and validate the program for identifying patterns and variations in coding practices with regular reports to the medical staff and management. - Assist in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality for clinical, financial, and administrative data. Qualifications - Citizenship: Citizen of the United States. - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Certification: Must have either Apprentice/Associate Level Certification, Mastery Level Certification, or Clinical Documentation Improvement Certification through AHIMA or AAPC. Requirements - One year of creditable experience equivalent to the journey grade level of a MRT (Coder). - Mastery level certification is required for all positions above the journey level. - Ability to research and solve complex questions related to coding conventions and guidelines in an accurate and timely manner. - Skill in interpersonal relations and conflict resolution to deal with individuals at all organizational levels. Benefits - Competitive salary and regular salary increases. - 37-50 days of annual paid time off per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year). - After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child. - After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs. - Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA. - Federal health/vision/dental/term life/long-term care insurance options. - This position is telework eligible but may be required to return to the office permanently at a later date.
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Role Description EXL Health is seeking an experienced Clinical Validation Auditor (CVA) Quality Analyst. This is a remote office opportunity. The Quality Analyst IV oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical DRG audits. A brief coding/auditing assessment may be included as part of the interview process. Estimated salary range is $60,100 to $98,700 plus bonus. Qualifications - Experience in clinical validation auditing. - Strong understanding of DRG audits. - Ability to perform quality reviews effectively. Requirements - Remote work capability. - Ability to meet EXL’s standard of accuracy. - Participation in a coding/auditing assessment during the interview process. Benefits - For more information on benefits and what we offer, please visit us at EXL Careers and Benefits .
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Title: Behavioral Health Auditor III Job Identification16205 Job RoleTotal Quality Management -Behavioral Health Experience (In Years)3-6 Job LocationRemote Job Description: We’re looking for a Behavioral Health Auditor III to join us in a fully remote role. In this position, you’ll use your knowledge of payer policies, industry standards, and regulatory guidelines to review and audit Behavioral Health claims. Your work will directly impact the integrity of healthcare payments and help ensure accurate, compliant practices across the industry. This isn’t just auditing—it’s about bringing insight, spotting trends, and helping shape the future of Behavioral Health payment integrity. Salary Range: $60,100 - $98,700* Location: 100% Remote (U.S.-based) Up to 10% annual travel (for team meetings and limited client onsite engagements.) Responsibilities What You’ll Do - Audit and review Behavioral Health claims to identify potential errors. - Analyze data against payer policies, procedures, and regulatory requirements. - Document findings clearly and professionally to support next steps. - Recommend claim adjustments or recoveries when necessary. - Collaborate with cross-functional teams to solve problems and drive improvements. - Stay ahead of the curve on regulations, laws, and industry standards. - Track and report audit findings, spotting trends and opportunities. - Share your expert knowledge to guide teams on Behavioral Health payment integrity issues. - Meet EXL’s productivity and quality goals while maintaining compliance with HIPAA and other regulations. Qualifications What We’re Looking For - Education: Bachelor’s degree in healthcare administration, business, finance, or a related field. - Experience: 3+ years in Behavioral Health services (mental health and substance use disorder treatment). - Credentials (Preferred): CCS, RHIA, RHIT, CPC, RN, MSW – bonus points if you have multiple! - Expertise: Strong understanding of Behavioral Health standards, payer policies, and regulations. - Bonus: Experience in Behavioral Health retrospective overpayment auditing. What You Bring - Ability to work independently in a fully remote environment. - Strong time management and prioritization skills. - A problem-solving mindset and ownership of results. - Excellent communication skills (both written and verbal). - Sharp analytical skills and great attention to detail. - Proficiency in Microsoft Excel, Word, and OneNote. - A passion for Behavioral Health auditing and a desire to thrive in a culture built on teamwork, collaboration, and excellence. Why Join EXL? At EXL, you’ll be part of a supportive, inclusive team that values expertise, collaboration, and growth. We believe in empowering our people to succeed while making a real impact on healthcare. If you’re ready to bring your Behavioral Health expertise to a role that values accuracy, innovation, and teamwork, we’d love to hear from you! *The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process. Required Skills - Certified Coding Specialist (CCS) - Certified Professional Coder (CPC) - Master of Social Work (MSW) - Registered Health Information Administrator (RHIA) - Registered Health Information Technician (RHIT) - Registered Nurse (RN) About Us EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.
Role Description RTX Corporation is seeking an experienced QMS (Quality Management System) Auditor to join our Enterprise Quality Audit (EQA) team (2nd Party Audit). The QMS Auditor will be responsible for conducting second party QMS audits across RTX business units to ensure compliance with 91XX series, ISO9001, and other relevant standards. This role will involve identifying areas of strength, opportunities and non-compliance, and reviewing and approving corrective action plans. The ideal candidate will have a strong background in quality assurance within the aerospace, space, and/or defense industries, along with excellent analytical and communication skills. What You Will Do: - Travel Requirements: This position requires 70% travel, both domestically and internationally, and can be located within convenient access to a major airport. Depending on audit schedules and auditor home location, this may include some weekend travel. - Audit Responsibilities: - Plan, lead, and/or conduct second party QMS audits for compliance with the 91XX and ISO series of standards, RTX and business unit policies & procedures, and regulatory and customer requirements across RTX sites. - Perform formal responsibilities of a lead auditor such as audit planning in conjunction with the EQA audit planner, representing the audit team with site leadership, conducting opening and closing meetings, and daily debriefs with site personnel. - Ensure that processes, products, and services comply with internal standards, regulatory requirements, and industry best practices. - Complete and issue detailed audit reports, including findings, non-conformances, and review and approve effective corrective actions and ensure implementation effectiveness. - May assist RTX Certification bodies during site surveillance and recertification audits, including facilitating audit schedules, logistics, and closure of corrective actions. - May support special projects relating to audits as needed. - Data Analysis: - Support analysis of audit performance to identify trends, risks, and opportunities for continuous improvement. - Utilize data analytics to support comprehensive audit preparation and planning based on historical and current performance data. - Collaboration: - Work closely with regional leads of the EQA team and Ops Excellence lead to support the audit schedule, ensuring that sites across RTX are audited per the schedule. - Foster collaborative relationships with functional and business leaders to promote a transformative quality organization aligned with business objectives. - Participate in weekly Corrective Action Review Board meetings to review and approve/reject formal corrective actions. - Special Audits and Assessments: - Support special audits (e.g., suspensions, major customer complaints, high-risk sites, etc.), independent assessments, and site certifications as required by RTX business units. Qualifications - Typically requires a University Degree and minimum 8 years prior relevant experience or an Advanced Degree in a related field and minimum 5 years of experience or in absence of a degree, 12 years of relevant experience. - Minimum of 5 years of experience in quality assurance, with at least 3 years in QMS auditing within the aerospace, space, and defense industries. - Familiarity with 91XX series and ISO9001 standards. - Current authenticated AS9100 Lead Audit certification (evidence is required). - Ability to certify within one year as an Aerospace Auditor (AA) or Aerospace Experienced Auditor (AEA). - The ability to obtain and maintain a secret U.S. government issued security clearance is required. Requirements - Certification as an Aerospace Auditor (AA) or Aerospace Experienced Auditor (AEA). - Existing AATT (Aerospace Auditor Transition Training) Certification (evidence is required). - Experience planning and coordinating multiple audits simultaneously. - Working knowledge of ETQ/ BU Corrective Actions processes/systems. - Proficiency in presenting audit results and concepts to key stakeholders and executive management. - ASQ Certification (CQA, CQE, CMQ/OE). - Existing Secret Security Clearance (for Raytheon’s DoD contracts). - CORE certification. - Proficiency with audit management software and tools. - Ability to function effectively without direct supervision. - Excellent analytical, organizational, and communication skills. Benefits - Robust total rewards package with compensation; healthcare, wellness, retirement and work/life benefits; career development and recognition programs. - Parental (including paternal) leave. - Flexible work schedules. - Achievement awards. - Educational assistance. - Child/adult backup care.
Huron is a global professional services firm elevating the vision of what's possible and then putting it into practice.
Role Description The Utilization and Denials Management Auditor is responsible for the day-to-day production and quality functions of a team of Utilization and Denials Management specialists specializing in meeting client production goals and accuracy goals. The Auditor assists Utilization and Denials management in preparing daily operational reports, providing QA (quality assurance) feedback, and participating in client interactions and internal stakeholder meetings. Key Responsibilities: - Quality Assurance (QA) & Delivery: - Assists in QA program build, including advising on critical aspects of the workflow/accounts to audit. - Monitors performance of all Utilization and Denials Management staff using key metrics. - Escalates Production and QA concerns or roadblocks to the Manager as needed. - Demonstrates domain expertise in quality processes related to meeting production schedules. - Deep understanding of both production and quality assurance Utilization and Denials Management processes. - QA Administration & Documentation: - Experience providing training, coaching, and development to team members. - Monitors and maintains team QA records and auditing/education findings. - Completes special projects, such as full Utilization and Denials Management audits. - Mentors staff to maximize performance and potential. - Assists in maintaining and monitoring team members' job satisfaction and morale. - Performance & Evaluation: - Reviews production and quality accuracy reporting for all assigned projects. - Motivates team members through effective training and coaching. - Conducts monthly team meetings and annual performance evaluations. - Collaboration & Stakeholder Management: - Partners with global Operations, Training, and HR to streamline onboarding. - Participates in client calibration calls to align training KPIs with operational metrics. - Supports client visits, internal audits, and process reviews. - Other duties and responsibilities as assigned. Qualifications - Required Qualifications: - QA Experience: At least 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in a healthcare setting. - Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience. - Education: Associate Degree in Nursing (ADN) or Diploma in Nursing. - Licensure: Must be Registered Nurse with an active USRN license. - RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines. - Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech. - Preferred Qualifications: - Education: Science in Nursing (BSN) preferred. - Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred. - Software Knowledge: Proficiency with using computer programs for tracking authorization, and/or denials and appeals. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint). Benefits - The estimated base salary range for this job is $80,000 - $105,000. - The job is also eligible to participate in Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs.
• support the development and implementation of the WTC Health Program’s Quality Assurance Plan, including the development and implementation of the WTC Health Program’s Audit Plan • use the WTC Health Program administrative manual, medical benefit plan resources, and other applicable Program guidance to support claims review, audit activities, prior authorization recommendations, and policy interpretation. • serve as an expert to the Program on claims processing and formal reviews (audits); supports Program claims reviews (audits) consistent with claims audits in the health insurance industry and the policies and procedures of the WTC Health Program. • conduct research and reviews of federal payor coverage determinations, administrative/clinical activities, for development of policies and procedures, completeness, and alignment with Program requirements. • analyze raw claims data to independently identify issues, patterns, and trends, and make final recommendations to the WTC Health Program on appropriateness for services within treatment/benefit plans, using health insurance reimbursement, medical coding/claims knowledge and expertise. • support management and maintenance of the Program’s health plan codebook, make recommendations for code additions, and review claims to ensure proper application of ICD, HCPCS, CPT, and DRG codes. • remain up to date with coding conventions, evidence-based practices, and federal payer policies. • continuously review and participate in industry changes and updates, specifically but not limited to, ICD-10-CM/OCS ad AMA CPT coding guidelines to look for, and develop ways, to evaluate, improve research strategy, processes, policies, and procedures within the WTC Health Program in accordance with the Research and Evaluation Branch’s and Quality and Evaluation Team’s functions and goals. • interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts to support medical management, claims review, audit activities, and prior authorization recommendations. • connect claims quality findings to broader quality assurance, utilization review, and program evaluation objectives, including identifying issues that may affect Program operations, reporting, or policy implementation.
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• Conduct coding audits of outpatient facility services, including ancillary procedures, PET scans, and simple visit encounters, to ensure coding accuracy and regulatory compliance. • Perform comprehensive audits and reviews of professional Evaluation and Management (E/M) documentation and coding to validate code assignment and reimbursement accuracy. • Provide ongoing feedback, education, and coaching to coding staff to improve coding quality, consistency, and adherence to coding guidelines. • Review and analyze clinical documentation and assigned codes from a variety of medical records to ensure accurate ICD-10-CM, CPT, and other applicable code assignment in accordance with current coding standards, regulatory requirements, and client-specific policies and guidelines.
• Independently audit clinical documentation to ensure consistent with billed services in a production environment • Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered • Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care. • Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly • Share ideas that offer process improvements and share with team for education.
Role Description Under the direction of the Sr. Manager of PCN Coding Integrity, the Coding Quality Educator will assist with the day-to-day operations of the PCN Coding Integrity Team and regional coding teams. This position will assist with: - New employee training and ongoing department education - Identification, development, and delivery of new and ongoing provider education and training related to coding and clinical documentation - Conducting independent and collaborative provider coding reviews according to the coding integrity work plan - Developing appropriate documentation to support coding review work performed Qualifications - Bachelor’s Degree in Management, Health Information Technology, or related field or an equivalent combination of education and experience - Upon hire: National Certification from American Academy of Professional Coders, or - Upon hire: National Certification from American Health Information Management Association - 4 years professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work; 5 years preferred - 4 years experience conducting medical coding provider audits and quality performance measures; preparing audit reports with recommendations; and providing provider education and feedback to facilitate improvement in documentation and coding; 5 years preferred - Strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment Requirements - Associate's Degree in a Healthcare related field (preferred) - 5 years experience in coding for multispecialty practice (preferred) - 2 years experience in professional fee billing methodologies (preferred) - Experience with IDX, Allscripts, Advanced Web, Meditech (preferred) - Experience with project management (preferred) Benefits - Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching - Health care benefits (medical, dental, vision) - Life insurance and disability insurance - Time off benefits (paid parental leave, vacations, holidays, health issues) - Voluntary benefits and well-being resources
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Title: Master Premium Insurance Auditor - Remote Location: United States Job Description: - Job Identification16032 - Job RoleTotal Quality Management -Premium Audit - Experience (In Years)3-6 - Job LocationRemote Job Description About the EXL Insurance Premium Audit Group: A leader in the field, EXL can complete all levels of premium audits on all auditable exposure types. We train our 450+ highly skilled professionals worldwide utilizing our industry-leading training platform and curriculum. This expertise is combined with a technology-enabled proprietary platform, with predictive modeling capabilities. Using a Premium Audit selection model, the team can predict the likelihood of policy misclassification, automatically assign audit methods to save carriers time and money, and use machine learning to continuously improve correlation and prediction accuracy. To learn more about the EXL Insurance Premium Audit Group visit us at www.exlservice.com/industries/insurance/premium-audit Why work for the EXL Insurance Premium Audit Team? - 17 days paid vacation, plus 8 paid holidays - Additional 10 paid sick days - Superb training program - Work from home - Competitive total compensation package and benefits with 401k - Career advancement opportunities - Discounted health club benefits in many areas around the U.S. - Paid Parental Leave - Laptop and other necessary office equipment provided Compensation: - Pay Type: Hourly plus production bonus incentives, in accordance with EXL’s policies - Total compensation for this position, which is a combination of an hourly base rate plus production bonus incentives, is targeted between $50K–$70K in total earnings within the first year.: - Hourly base rate is dependent upon job specific experience and location. - There is no cap on production bonus incentives The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process. ***Applicants must have at least 2 years of experience in a premium auditor role*** Responsibilities The Role and Responsibilities: Working from your home office, this role requires scheduling appointments with the insured to be audited and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards. Territory: Remote Qualifications Qualifications: - Must have at least 2 yrs experience - Ability to work independently from home. - Experience with the MS Office Suite (excel, word, outlook, etc.) - Must be self-motivated, self-disciplined and exhibit a willingness to learn. - Excellent time management - Excellent verbal and written communication skills - Working knowledge of insurance and / or basic accounting principles is a plus.} - High School Diploma or GED required Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL salary range for this position. Actual salaries will vary depending on factors including but not limited to location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, a Paid Time Off policy, and many region-specific benefits. Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy. EEO/Minorities/Females/Vets/Disabilities Application & Interview Impersonation Warning– Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s). EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
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