audit specialist

Terribles

<div><p>It's fun to work in a company where people truly BELIEVE in what they're doing!
</p><p></p><p><i>We're committed to bringing passion and customer focus to the business.
</i></p><p></p><p><b>Position Summary
</b></p><p>The Auditor is responsible for performing daily audit functions and supporting hotel accounting operations to ensure the accuracy, integrity, and completeness of all financial transactions. This position reconciles revenues, balances cash and electronic payment activity, audits departmental transactions, prepares daily financial reports, investigates discrepancies, and ensures compliance with company policies and internal controls. The Auditor plays a critical role in maintaining accurate financial records and supporting operational and financial compliance across the resort.
</p><p><b>Essential Duties and Responsibilities:
</b></p><p><b>Daily Audit Functions
</b></p><ul><li>Perform the daily audit process and successfully close the business day within the Property Management System (PMS) and other applicable operating systems.
</li><li>Audit hotel, food and beverage, retail, and other departmental transactions to ensure all revenues and charges have been accurately recorded.
</li><li>Verify guest folios, departmental postings, and account balances for completeness and accuracy.
</li><li>Post room charges, taxes, resort fees, miscellaneous charges, and approved adjustments.
</li><li>Review system-generated reports and identify discrepancies requiring correction or follow-up.
</li><li>Maintain complete, organized, and accurate audit documentation in accordance with company standards.
</li></ul><p><b>Financial Reconciliation
</b></p><ul><li>Reconcile and balance daily financial transactions, including cash, credit card, electronic payment, and other revenue activity.
</li><li>Balance guest ledgers and departmental reports against supporting documentation.
</li><li>Investigate and resolve discrepancies involving guest accounts, deposits, billing, revenue postings, payment processing, and departmental transactions.
</li><li>Ensure compliance with accounting procedures, internal controls, and company financial policies.
</li><li>Prepare daily balancing reports, revenue summaries, and audit documentation.
</li></ul><p><b>Reporting and Administrative Responsibilities
</b></p><ul><li>Generate, compile, and distribute daily operational, occupancy, financial, and management reports.
</li><li>Prepare reports required by Finance, Accounting, and resort leadership.
</li><li>Maintain accurate audit records, reconciliation logs, and financial filing systems.
</li><li>Communicate financial discrepancies, operational concerns, and system issues promptly to management.
</li><li>Assist with month-end closing activities, special projects, and additional accounting assignments as needed.
</li><li>Perform other duties as assigned.
</li></ul><p><b>Qualifications:
</b></p><p><b>Education
</b></p><ul><li>High school diploma or GED required.
</li><li>Associate degree or coursework in Accounting, Finance, Business Administration, Hospitality, or a related field preferred.
</li></ul><p><b>Experience
</b></p><ul><li>Minimum one (1) year of accounting, auditing, hospitality, finance, cashiering, or related experience preferred.
</li><li>Previous hotel or resort experience preferred.
</li><li>Experience handling cash reconciliation, balancing financial transactions, and account reconciliation preferred.
</li><li>Experience using Property Management Systems (PMS), accounting software, or financial reporting systems preferred.
</li></ul><p><b>Knowledge, Skills, and Abilities
</b></p><ul><li>Strong mathematical, accounting, auditing, and reconciliation skills.
</li><li>Excellent attention to detail with the ability to accurately identify and resolve discrepancies.
</li><li>Working knowledge of accounting principles, audit procedures, financial reporting, and internal controls.
</li><li>Strong analytical, organizational, and problem-solving skills.
</li><li>Excellent verbal and written communication skills.
</li><li>Ability to maintain confidentiality and handle sensitive financial information with integrity.
</li><li>Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook.
</li><li>Ability to work independently while meeting strict deadlines.
</li><li>Strong organizational and time management skills.
</li><li>Ability to prioritize multiple assignments in a fast-paced environment.
</li></ul><p><b>Licenses and Certifications
</b></p><ul><li>Ability to obtain and maintain all work cards, permits, and certifications required by local, state, and company regulations.
</li></ul><p><b>Physical Requirements
</b></p><ul><li>Ability to sit and work at a computer for extended periods.
</li><li>Ability to stand and walk periodically throughout the workday.
</li><li>Ability to lift, push, pull, and carry up to 25 pounds occasionally.
</li><li>Ability to perform repetitive hand and finger movements for keyboard and calculator use.
</li><li>Ability to work weekends, holidays, and flexible schedules as business needs require.
</li></ul><p><b>Work Environment
</b></p><ul><li>Fast-paced resort and hospitality environment operate 24 hours a day, 7 days a week.
</li><li>Frequent interaction with Finance, Accounting, hotel departments, management, and guests.
</li><li>Responsible for ensuring the accuracy, integrity, and confidentiality of financial records and daily revenue reporting.
</li></ul><p><b>Core Competencies
</b></p><ul><li>Financial Accountability
</li><li>Attention to Detail
</li><li>Integrity and Confidentiality
</li><li>Analytical Thinking
</li><li>Problem Solving
</li><li>Communication
</li><li>Teamwork and Collaboration
</li><li>Time Management
</li><li>Organizational Skills
</li><li>Adaptability
</li><li>Sound Judgment
</li></ul><p></p><p><i>If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!</i></p></div>

Auditor - Primm Valley Casino Resorts

<div><p><b><i>About Emirates Global Aluminium</i></b><i>
</i></p><p>Emirates Global Aluminium is the world&rsquo;s biggest &lsquo;premium aluminium&rsquo; producer and the largest industrial company in the United Arab Emirates outside the oil and gas industry. EGA is an integrated aluminium producer, with operations on four continents from bauxite mining to the production of cast primary aluminium and recycling. EGA employs over 7,000 of these people including more than 1,200 UAE Nationals. EGA operates aluminium smelters in Jebel Ali and Al Taweelah in the United Arab Emirates, an alumina refinery in Al Taweelah, a bauxite mine and associated export facilities in the Republic of Guinea, a speciality foundry in high strength recycled aluminium in Germany, and a recycling plant in the United States.</p>
<div><b>Senior Auditor</b></div>
<div><b>Internal Audit</b></div><br>
<div></div><div><ul><li><b>JOB PURPOSE</b></li></ul><br>
</div><div></div><div>To assist the Principal Auditor in conducting and delivering internal audit services for a specific assignment. The senior auditor shall under the guidance of the Manager IA , carry out parts of the overall audit while ensuring that professional standards are met, areas of non-compliance are identified and addressed to mitigate the risk</div><br>
<div></div><div><ul><li><b>KEY ACCOUNTABILITIES</b></li></ul><br>
</div><div></div><p><b>Policies, Processes &amp; Procedures</b></p>
<div>Implements approved departmental policies, processes and procedures to ensure that work is carried out in accordance with the professional standards issued by The Institute of Internal Auditors.</div><br>
<div></div><p><b>Day-to-Day Operations</b></p>
<div>Implements the day-to-day operations assigned for the Internal Audit function to ensure compliance with the established standards and procedures and EGA audit methodology</div><br>
<div></div><p><b>Risk Assessment and Audit Plans</b></p>
<div>Participates in the risk assessments carried out by the Senior Manager/Manager for the assigned area of responsibility.</div><br>
<div></div><p><b>Internal Audit Activities</b></p>
<div>Carries out parts of the overall audit including but not limited to: a) participating in determining the audit approach including risk analysis and process mapping; b) conducting the testing of internal controls; c) identify process improvements and cost reduction opportunities; and d) assess the adequacy of internal controls</div><br>
<div></div><p><b>Documentation</b></p>
<div>Prepares work papers to ensure that the audit objectives and the quality standards are met and working papers or audit files are maintained as per Internal Audit methodology</div><br>
<div></div><p><b>Corrective Actions</b></p>
<ul><li>Assists in developing suitable recommendations to mitigate/remediate the observations made and risks highlighted. In particular this will include ensuring that all accepted recommendations are given clear implementation deadlines or clearly identified as not being accepted.</li>
<li>Ensures that Senior Manager IA / Principal Auditor is informed in a timely manner regarding critical issues to enable quick correction and mitigation of further occurrences.</li>
<li>Carries out the periodic follow-up of recommendations and report on status of implementation.</li><br>
</ul><div></div><p><b>Reports</b></p>
<div>Prepares draft observations pertaining to the work assigned as per the required format for review by the audit team leader</div><br>
<div></div><p><b>Management Requests and Fraud Investigation</b></p>
<div>Participate in ad-hoc reviews based on management requests and/or fraud investigations, as directed by more senior members of the Internal Audit team</div><br>
<div></div><p><b>Safety, Quality &amp; Environment</b></p>
<div>Complies with all relevant safety, quality and environmental management policies, procedures and controls to ensure a healthy and safe work environment</div><br>
<div></div><div><ul><li><b>AUTHORITY / DECISION MAKING</b></li></ul><br>
</div><div></div><div>The Senior Auditor is required to interact and maintain effective working relationships with line management of the assigned area of responsibility</div><br>
<div></div><div><ul><li><b>QUALIFICATIONS &amp; SKILLS<br>
</b></li></ul></div><div></div><p><b>Minimum Qualifications:</b></p>
<ul><li>Bachelor&rsquo;s degree in Finance / Accounting / Engineering and working towards a professional qualification from a recognised International Accounting Institutes (e.g. CPA/CIMA/CMA/CA)</li>
<li>Audit related professional qualification such as CIA or CISA</li><br>
</ul><div></div><p><b>Minimum Experience:</b></p>
<ul><li>Minimum of 3-6 years internal audit / relevant business process experience in a large manufacturing company or with the Big4 audit firms.</li><br>
</ul><div></div><p><b>Skills:</b></p>
<ul><li>Knowledge of the manufacturing industry with particular exposure to the metal industry in general and Aluminium industry in particular.</li>
<li>Intermediate knowledge of IIA Standards on Professional Practice and Code of Ethics</li>
<li>Intermediate knowledge of international corporate/IT governance, risk and internal controls frameworks such as COSO, ERM, COBIT, etc.</li>
<li>Good analytical and observation skills. Knowledge of data analysis techniques and computer assisted audit tools such as ACL/IDEA would be an advantage.</li>
<li>Adequate language skills (English) and effective communication skills, both written and oral.</li>
<li>Must have sufficient knowledge to be able to identify red flags in the processes and be able to assess the risk of fraud stemming therefrom.</li>
<li>One or more of the following:</li>
<li><div><ul><li>Intermediate knowledge of IT processes including IT Governance, IT ISO, IT Security, etc.</li>
<li>Intermediate knowledge of the Aluminium smelting plant processes and operations including technical aspects</li>
<li>Intermediate knowledge of IFRS, finance function, accounting practices, JVs, financial analysis, etc.</li>
<li>Intermediate knowledge of processes such as HR, supply chain, marketing &amp; sales, treasury etc</li></ul></div></li></ul></div><div></div>

Senior Auditor

Thrivent

<p></p><div>We exist to help people achieve financial clarity. At Thrivent, we believe money is a tool, not a goal. Driven by a higher purpose at our core, we are committed to providing financial advice, investments, insurance, banking and generosity programs to help people make the most of all they&rsquo;ve been given.
<br>
<br>
At our core, we are a membership-owned fraternal organization, as well as a holistic financial services organization, dedicated to serving the unique needs of our clients. We focus on their goals and priorities, guiding them toward financial choices that will help them live the life they want today&mdash;and tomorrow.<br>
<br>
Job Summary<br>
<br>
Responsible for planning, organizing, conducting, and reporting the results of individual internal audit projects, as part of the Company&rsquo;s internal audit program. Maintains strong relationships with stakeholders, staying abreast of changes in business activities, performing risk assessments and contributing to the development of the overall internal audit plan. Develops and oversees the execution of the individual audit test plan, supervising staff auditors, as necessary. Performs a variety of internal audit assignments applying audit principles and techniques in audit testing and fact gathering. Provides Business Risk Management (BRM) leadership with objective analyses and appraisals developed in conjunction with BRM&rsquo;s reviews of financial, operational and regulatory compliance activities. Completes work assignments with minimal supervision individually or as part of a team.<p><br>
</p><p></p><p><b>Job Responsibilities and Duties
</b></p><ul><li>Conduct moderate to complex audit and consulting activities in accordance with the established internal audit program to ascertain whether company policies and procedures, and other risk management activities are designed and operating effectively to manage business risks within established tolerances.</li><li>
Perform planning activities to develop the project scope and appropriate test procedures for audits. This includes, among other things, conducting the opening meeting with management, obtaining and analyzing information to ascertain risks, documenting processes and controls and monitoring the appropriateness of the original audit plan and amending the plan as necessary.</li><li>
Establish reasonable project time budgets, monitoring the progress of the project, completing the project on time and reporting results to BRM management.</li><li>
Ensure work is performed competently and in accordance with BRM and internal audit professional standards. Interpret testing results against defined criteria to formulate cost effective recommendations. Prepare workpapers to document relevant facts and information that support the work performed and conclusions drawn so other reviewers can follow the auditor&rsquo;s logic and methodology.</li><li>
Evaluate and document issues and audit reports in accordance with BRM standards and communicate audit results to audit stakeholders.</li><li>
Assist on a variety of internal departmental projects, as assigned, and participate in professional development activities.</li><li>
Keep abreast of developments in internal auditing and the industries in which Thrivent operates.</li><li>
Complete assigned tasks independently but under supervision of audit leaders, with occasion to supervise and coach more junior auditors.</li><li>
Model Thrivent&rsquo;s leadership competencies &ndash; Model the Way, Rally the Team, and Deliver Outcomes by demonstrating resiliency, working together to make the best decisions, and holding yourself and others accountable.
</li><li>Support and/or develop an environment in which Thrivent employees and colleagues are focused on continuous improvement, exceptional employee engagement, and an unwavering commitment to our clients. Shape and/or support a culture that represents the Thrivent purpose, promise and values, ensuring that Thrivent&rsquo;s trust and reputation remain strong with its clients.
</li></ul><p></p><p><b>Job Qualifications
</b></p><p></p><p><b>Required:</b></p><ul><li>
Bachelor&rsquo;s degree in business administration, accounting or finance (other degrees considered with sufficient, relevant work experience). Advanced degree desirable.</li><li>
Minimum of five years of work experience, including internal audit, risk management or financial services experience.</li><li>
Understanding of internal control concepts and demonstrated experience applying them to plan, perform, manage, and report on the evaluation of various business processes/areas/functions.</li><li>
Has or intends to obtain certification in internal auditing, public accounting, or relevant industry designation (e.g., CIA, CPA, CFIRS, CAMS, CISA, CFA, CFSA, JD, CLU, ChFC, or FLMI).</li><li>
Effective verbal and written communication abilities.</li></ul><p></p><p><b>
Preferred:</b></p><ul><li>
Strong communicator with demonstrated ability to build collaborative relationships and perform effectively as part of a team.</li><li>
Strong project management skills including organization and time management.</li><li>
Demonstrated ability to apply sound judgement and make decisions in situations involving ambiguity.</li></ul><p></p><p><b>
Additional Information</b></p><ul><li>
This position allows for a hybrid working environment meaning you may work on-site and remotely from the Minneapolis, MN or Appleton, WI corporate offices.</li></ul><p></p><p><br>
</p>Pay Transparency<br>
<p></p>
Thrivent&rsquo;s long-term growth depends on attracting, rewarding, and retaining people who are committed to helping others thrive with purpose. We accomplish this by offering a wide variety of market competitive compensation programs to attract, reward, and retain top talent. The applicable salary or hourly wage range for this full-time role is $89,895.00 - $121,621.00 per year, which factors in various geographic regions. The base pay actually offered will be determined by a variety of factors including, but not limited to, location, relevant experience, skills, and knowledge, business needs, market demand, and other factors Thrivent deems important.<br>
<p></p>
Thrivent is unique in our commitment to helping people to be wise with money and live balanced and generous lives. That extends to our benefits.<br>
<p></p>
The following benefits may be offered: various bonuses (including, for example, annual or long-term incentives); medical, dental, and vision insurance; health savings account; flexible spending account; 401k; pension; life and accidental death and dismemberment insurance; disability insurance; supplemental protection insurance; 20 days of Paid Time Off each year; Sick and Safe Time; 10 paid company holidays; Volunteer Time Off; paid parental leave; EAP; well-being benefits, and other employee benefits. Eligibility for receipt of these benefits is subject to the applicable plan/policy documents. Thrivent&rsquo;s plans/policies are subject to change at any time at Thrivent&rsquo;s discretion.<p></p><p><i><br>
Thrivent provides Equal Employment Opportunity (EEO) without regard to race, religion, color, </i><i>sex</i><i>, gender identity, sexual orientation,</i><i> pregnancy, </i><i>national origin, age, disability, marital status, citizenship status, military or veteran status,</i><i> </i><i>genetic information, or any </i><i>other</i><i> </i><i>status </i><i>protected by applicable local, state</i><i>,</i><i> or federal law. This policy applies to all employees and job applicants.</i></p><p></p><p><i>
Thrivent is</i><i> committed to providing reasonable accommodation to individuals with disabilities. If you need a reasonable accommodation</i><i>, </i><i>please let us know by sending an email to </i><i>human.resources@thrivent.com</i><i> or call </i><i>800-847-4836</i><i> and request Human Resources.</i></p></div><p></p>

AlignRx LLC

<p>AlignRx is a Public Benefit LLC (PBLLC)&mdash;a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.</p><p>As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.</p><p>Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers resulting in improved patient care and outcomes.</p><p><b>Job Summary</b></p><p>This position is responsible for PBM Audits including analyzing claims data to resolve claims issues, identifying claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit. This position will identify and maintain PBM specific documentation requirements for hardcopy prescriptions and maintain information on PBMs that have requirements that exceed State Pharmacy Law. This position may assist management in tracking/trending pharmacy audit/recovery/appeal statistics. This position serves English and Spanish speaking pharmacy clients with the preference to communicate professionally and effectively in both languages.</p><p><b>Essential Job Functions </b></p><ul><li>Audit preparation and support including analyzing claims data to resolve claims issues, identify claims most likely to be audited, reviewing prescription hardcopies to identify potential gaps in documentation requirements, and preparing pharmacy reports to support the pharmacy in preparing for audit.</li><li>Complete audits for external clients timely and accurately by following all departmental policies and procedures.</li><li>Follow-up to monitor PBM compliance with state law requirements, including actively monitoring timelines for audit.</li><li>Coordination of technician training requests. CPhT certification.</li><li>Maintenance of state/federal law documentation and PBM specific billing requirements.</li><li>Interaction, by phone or onsite in person, with pharmacy clients to facilitate preparation and submission of audit and appeals.</li><li>General audit appeal assistance as directed.</li><li>Perform other duties and projects as required by management.</li></ul><p><b>Additional Responsibilities </b></p><ul><li>Other duties as assigned or required.</li></ul><p><b>Minimum Qualifications for Consideration </b></p><ul><li>CPhT or National Technician Certification required.</li><li>HS Graduate, college degree preferred.</li><li>Two or more years&rsquo; experience as a pharmacy technician in a retail/community pharmacy environment.</li><li>PBM experience a plus.</li><li>Ability to speak/read/write English with fluency; preference Bilingual English/Spanish.</li></ul><p><b>Knowledge, Skills, and Abilities:</b></p><ul><li>Excellent verbal and written communication skills.</li><li>Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.</li><li>Able to effectively manage time and prioritize projects in order to meet established deadlines.</li><li>Demonstrate dependability through good attendance and adherence to timelines and schedules.</li><li>Good follow-through on projects and deliverables.</li><li>Good analytical skills.</li><li>Good problem-solving skills.</li><li>Demonstrate resourcefulness and ability to take initiative in development and completion of projects.</li><li>Strong sense of customer service.</li><li>Strong proficiency in pc applications which include: Microsoft Windows, Internet, database, word processing (WORD), spreadsheets (EXCEL), presentation software (POWERPOINT), email (OUTLOOK) and file management skills. Able to learn company-specific applications.</li><li>Knowledge of and experience in the industry with regards to terminology and functions for retail/other pharmacy.</li><li>Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), etc.</li><li>Knowledge and understanding of how and why pharmacy claims process: i.e. calculation of copayments, pricing hierarchies, etc.</li></ul><p><b>Physical requirements/Working Conditions </b></p><ul><li>This work is sedentary and requires the following physical activities:</li></ul><p>Sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.</p><p>Frequent lifting (up to 20 pounds of paper supplies or minor office equipment).</p><p>Travel to client locations and other sites as needed.</p><p>Normal remote office environment.</p><p>Remote.</p><p><b>Direct reports</b></p><ul><li>None.</li></ul><p><b>Benefits</b></p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul><p>NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.</p><p><i>AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation, and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.</i></p><p>Pay: From $20.50 per hour</p><p>Education:</p><ul><li>High school or equivalent (Required)</li></ul><p>Experience:</p><ul><li>Pharmacy tech in a retail/community pharmacy environment: 2 years (Required)</li><li>PBM: 1 year (Preferred)</li></ul><p>Language:</p><ul><li>English and Spanish, including speaking, reading and writing (Required)</li></ul><p>License/Certification:</p><ul><li>CPhT or National Technician Certification (Required)</li></ul><p>Work Location: Remote</p>

RxProtect Analyst, English/Spanish Bilingual

McMaster Supply Group

<p>&middot; Organize and save Data Sheets, Catalogues, MSDS, and vendor quotes with key details.</p><p>&middot; Maintain proper folder structure, file naming, and document extraction from emails.</p><p>&middot; Link updated vendor prices and ensure accurate sales and purchase descriptions.</p><p>&middot; Avoid duplicate product links; create new products with correct specs when needed.</p><p>&middot; Verify SO details (serial number, quantity, value) against customer PO.</p><p>&middot; Update DG goods/sensitive info in Purchase &amp; Sales alerts.</p><p>&middot; Conduct internal audits before PO confirmation and ensure compliance with policies.</p><p>&middot; Inspect received materials for accuracy in model, P/N, brand, and condition.</p><p>&middot; Ensure correct UOM selection and update payment terms in vendor records.</p><p>&middot; Report issues via tickets and save consignment pictures/videos before logistics handover.</p><p>&middot; Receive calls and update on the caller details to the relevant stake holders.</p><p>&middot; Any other task (s) assigned by the management.</p><p>&middot; Sales Orders, LOST cases, Decline cases, Product, Vendors Audit, Customer Audit, ERP Process Improvement</p><p>&middot; Data modification requests, Plan &amp; revise delivery dates exception on Purchase Orders, Exception of extra Qty on Purchase Orders</p><p>&middot; Training new Hirings, Checklist updating</p><p>&middot; Ticket resolving, Duplicate brands campaign</p><p>Pay: Rs80,000.00 - Rs110,000.00 per month</p><p>Work Location: In person</p>

Process Auditor

UF Health

<div>Overview:
<div><b>
Job Duties</b></div><div>
Under limited supervision, the Lead Physician Billing Compliance Analyst (Lead) will perform physician<br>
coding/documentation reviews for providers of the University of Florida Jacksonville Physicians Group (UFJPI). Audit focus<br>
will be on physician/non-physician practitioner coding and chart documentation to include review of E&amp;M, CPT-4, ICD-10,<br>
Level II HCPCs, Teaching Physician guidelines and carrier specific policies. The Lead will prepare and present accurate<br>
reports of audit findings to appropriate personnel. The Lead will coordinate with various UFJPI representatives to ensure<br>
that any resulting refunds are processed and educational needs are addressed. The Lead will assist the Manager with<br>
monitoring and recording of productivity and quality of staff and will train staff on job duties and work flow processes. The<br>
Lead will ensure all job duties are covered when personnel are on vacation or ill. The Lead will handle routine personnel<br>
issues and act as the liaison between the Manager and Office of Compliance (OOC) staff.</div>
Responsibilities:
<div><b>
Essential Functions</b></div><ul><li>Perform audit reviews of medical providers of the UFJPI within designated timeframes.</li><li>Identify ongoing problems in audit process and notify manager when issues surface.</li><li>Audit chart documentation for accurate coding and to verify that chart documentation supports services billed.</li><li>Audit chart documentation for compliance with E&amp;M, CPT procedure coding, ICD-10-CM diagnosis coding, Teaching Physician guidelines, payer specific polices and regulatory requirements.</li><li>Prepare accurate audit reports that include summary spreadsheets of audit findings.</li><li>Perform analysis of audit findings and summarize by individual records for placement in the OOC central database. Present audit results to appropriate faculty and billing personnel.</li><li>Identify remedial training needs through audit process and if necessary conduct remedial training with provider or billing staff.</li><li>Identify, locate and obtain medical record documentation necessary to accurately complete audits.</li><li>Perform quality assessments on work product of Analysts and Research Assistants in accordance with departmental policies and procedures.</li><li>Assist in the development of policies and procedures to ensure work is performed and completed in accordance with the University of Florida College of Medicine Billing Compliance Plan</li><li>All other duties as assigned</li><li>Travel up to 10%</li></ul>
Qualifications:
<div><b>
Experience Requirements</b></div><div>
2 years Medical billing required<br>
5 years Medical coding (procedural and diagnosis) for multi-specialty providers required<br>
4 years Medicare, Medicaid, and Tricare payment and reimbursement rules required<br>
4 years Medical record chart auditing for professional billing required<br>
1 year Supervisory or project management required<br>
1 year medical management information systems (EPIC preferred) required<br>
1 year Auditing software applications (e.g MDaudit, Compliance Risk Analyzer) preferred<br>
<b>Education
</b></div><div>High School Diploma or GED equivalent required<br>
Associates Business or Health care related field preferred<br>
<b>Certificate/Licensure
</b></div><div>Certified Coding Specialist required or at time of hire<br>
Certified Coding Specialist - Physician Based<br>
(CCS-P) - AHIMA<br>
required or at time of hire<br>
Certified Professional Coder (CPC) required or at time of hire<br>
Certified Professional Medical Auditor (CPMA) required at time of hire</div><div><b>
 UFJPI is an Equal Opportunity Employer and Drug Free Workplace</b></div></div>

Billing Compliance Analyst Team Lead | Phys Billing Compliance - Hybrid | Days | Full Time

Centene

<div><p>You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility.<br>
</p><p><b>Remote Role: </b>Minimum experience required 6+ years Performing MS-DRG and APR-DRG coding experience and 3+ years Conducting DRG reviews for a Payment Integrity vendor or payer experience.</p><p><b>
Position Purpose:</b><br>
Supervise and coordinate the day-to-day activities of the Coding &amp; Clinical Review team within Payment Integrity, ensuring accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives. This role executes strategies and initiatives established by leadership while driving team performance, quality, operational efficiency, and consistent application of coding and clinical review standards. The position may oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams and serves as a subject matter expert for complex coding, clinical validation, and audit-related matters. This role also adheres to and promotes American Health Information Management Association Code of Ethics and professional standards.</p><ul><li>
Supervise and coordinate daily work activities of Coding &amp; Clinical Review staff to ensure timely and accurate completion of DRG audit, QA, readmissions, appeals, and/or operational workflows</li><li>
Monitor and evaluate team performance against established productivity, quality, and service level expectations; take appropriate action to address gaps</li><li>
Provide guidance and direction on coding, clinical validation, and audit determinations in accordance with ICD-10-CM/PCS guidelines, DRG methodologies, and applicable payer and regulatory policies</li><li>
Review and resolve complex or escalated cases; elevate high-risk issues to management as appropriate</li><li>
Implement and support departmental policies, procedures, and program initiatives to ensure consistent execution of Payment Integrity strategies</li><li>
Conduct quality assurance activities including audits, calibration sessions, and inter-rater reliability reviews to ensure consistency and accuracy of determinations</li><li>
Support appeals processes by reviewing clinical documentation, validating determinations, and guiding response development</li><li>
Analyze operational and audit data to identify trends, variances, and improvement opportunities; communicate findings to management</li><li>
Ensure compliance with regulatory requirements, internal policies, payer guidelines, and AHIMA ethical standards; reinforce a culture of integrity and accountability</li><li>
Collaborate with cross-functional partners (e.g., Medical Directors, Provider Relations, Compliance, Appeals) to address issues and improve outcomes</li><li>
Assist with staff selection, onboarding, training, and workforce planning</li><li>
Participate in and support process improvement efforts to enhance efficiency, quality, and financial performance</li><li>
Performs other duties as assigned.</li><li>
Complies with all policies and standards.</li></ul><p><b><br>
Education/Experience:</b><br>
<br>
Associate's Degree in Health Information Management, Nursing, or related field required<br>
<br>
<b>6+ years Performing MS-DRG and APR-DRG coding experience required</b><br>
<br>
<b>3+ years Conducting DRG reviews for a Payment Integrity vendor or payer experience required</b><br>
<br>
<b>3+ years DRG encoder/grouper experience (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar) experience required</b><br>
<br>
<b>1+ years Inpatient hospital documentation improvement, complex appeal/dispute review, or auditor education/training experience preferred</b><br>
<br>
<b>Licenses/Certifications:</b><br>
<br>
<b>RHIT - Registered Health Information Technician required or:</b><br>
<b>CCS-Certified Coding Specialist required or: (CIC) required or</b><br>
<br>
<b>Certified Clinical Documentation Specialist (CCDS) required or:</b> RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse (in combination with a coding credential) preferred</p>
Pay Range: $87,700.00 - $157,800.00 per year<p>
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.</p><p>
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.</p><p><br>
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</p></div>

Supervisor, Payment Integrity- Coding & Clinical (DRG)

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Supervisor, Payment Integrity- Coding & Clinical (DRG)