1233 compliance analyst jobs found

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral, transportation and other services. The role includes auditing records, summarizing findings, and communicating with investigators and regulators. The position requires CPC certification, 3+ years in coding/auditing, strong knowledge of CPT/HCPCS/ICD-10, and proficiency in Excel and Word. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral, transportation and other services. The role includes auditing records, summarizing findings, and communicating with investigators and regulators. The position requires CPC certification, 3+ years in coding/auditing, strong knowledge of CPT/HCPCS/ICD-10, and proficiency in Excel and Word. #J-18808-Ljbffr

Join to apply for the Compliance Auditor Analyst role at Upstate Medical University 5 months ago Be among the first 25 applicants Join to apply for the Compliance Auditor Analyst role at Upstate Medical University Get AI-powered advice on this job and more exclusive features. Job Summary Position Summary: Under the direction of the Compliance Officer the main duties for this position include: analysis of professional coding and billing data, review of applicable regulations or guidelines and professional coding and billing audits. Duties/Responsibilities Analysis of coding and billing data, identification of trends and aberrations. Performance of routine and investigatory audits evaluating compliance with applicable laws, regulations, coding, and billing guidelines. Interpretation of coding, billing, and regulatory standards. Preparation and completion of audit reports including recommendations, education and corrective action. Knowledge, Skills and Abilities: Strong...

The AI Audit Analyst is responsible for conducting risk assessments, reviews, special projects, and other activities on Artificial Intelligence (AI) solutions for the enterprise, across all lines of business and functions, to ensure Elevance Health develops and deploys AI technologies consistent with our internal standards, policies, contracts, laws, and regulations. This position is an exciting opportunity to provide valuable insights to the AI business to improve the effectiveness of risk management, monitoring, and governance processes. How you will make an impact: Assists the development and execution of high-quality risk assessments of AI solutions. Perform reviews of AI solutions, testing for compliance to Elevance Health standards, policies, and regulations. Identify risks and collaborate with AI system team leadership and business management on testing and evaluation procedures, which includes working with the AI business on process, controls, documentation, and...

Mascoma Bank is seeking an IT Audit & Compliance Analyst to join its Information Technology team in Hartford, Vermont. The role involves supporting risk, audit, and access governance programs, reviewing user access, and ensuring compliance with regulatory requirements. Ideal candidates will have a Bachelor's degree in a related field and 3-5+ years of IT audit experience. The position offers a salary range of $80,000 - $90,000 depending on experience, and emphasizes a commitment to diversity and inclusion. #J-18808-Ljbffr

Ports North is seeking an experienced Interim HR Compliance Analyst for a short-term assignment in Austin. This role focuses on digitizing HR employee records and conducting I-9 audits to ensure compliance with federal regulations. The ideal candidate will have prior HR compliance experience, strong attention to detail, and a working knowledge of employment eligibility requirements. Responsibilities include organizing personnel files and delivering audit summaries. #J-18808-Ljbffr

Five Rivers IT, Inc in Fair Lawn is seeking a Senior IT Security Compliance Analyst to lead audits and manage compliance initiatives for a diverse client base. This full-time role focuses on governance, risk, and compliance, offering competitive compensation ranging from $125,000 to $175,000. The ideal candidate will have a Bachelor's degree and over 5 years of experience in Information Security audits. Benefits include medical, dental, vision insurance, and a supportive environment for professional certification. #J-18808-Ljbffr

UT Southwestern Medical Center in Dallas seeks a Compliance Analyst III to lead complex hospital billing audits, regulatory reviews, and investigations, providing expert guidance on Medicare, Medicaid, and payer requirements. This senior role partners with revenue cycle and clinical teams, develops education materials, and strengthens controls to ensure accurate reimbursement and regulatory compliance. Qualifications include a Bachelor's in business or healthcare admin, 5 years in compliance, #J-18808-Ljbffr

Compliance Auditor needed! Join our growing organization! Onco360 has an immediate need for a Compliance Auditor. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Remote opportunity! Some Travel required - see details below Starting Salary at $60,000 and up, depending on experience Summary: The Compliance Auditor will assist the Onco360/CareMed/ConnectMed360 Compliance Team through the completion of routine and random pharmacy compliance audits at Onco360/CareMed/ConnectMed360 pharmacy locations to ensure all pharmacy activities and operations are executed in compliance with state and/or federal regulations and laws governing pharmacy operations. This individual provides support to Onco360/CareMed/ConnectMed360 pharmacy operations teams in answering compliance and regulatory questions based around their needs. The Compliance Auditor shall develop and...

Compliance Auditor needed! Join our growing organization! Onco360 has an immediate need for a Compliance Auditor. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Remote opportunity! Some Travel required - see details below Starting Salary at $60,000 and up, depending on experience Summary: The Compliance Auditor will assist the Onco360/CareMed/ConnectMed360 Compliance Team through the completion of routine and random pharmacy compliance audits at Onco360/CareMed/ConnectMed360 pharmacy locations to ensure all pharmacy activities and operations are executed in compliance with state and/or federal regulations and laws governing pharmacy operations. This individual provides support to Onco360/CareMed/ConnectMed360 pharmacy operations teams in answering compliance and regulatory questions based around their needs. The Compliance Auditor shall develop and...

A leading staffing and IT solutions provider is seeking a Compliance Analyst for a 6-month contract in Tampa, FL. The role involves coordinating government and compliance documents, analyzing complex issues, and developing risk mitigation strategies. Ideal candidates will have 2-3 years of experience in risk management, a strong audit background in financial institutions, and exceptional communication skills. This position offers a competitive hourly rate of $34 to $36. #J-18808-Ljbffr

Compliance Auditor needed! Join our growing organization! Onco360 has an immediate need for a Compliance Auditor. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting Salary at $60,000 and up, depending on experience Summary The Compliance Auditor will assist the Onco360/CareMed/ConnectMed360 Compliance Team through the completion of routine and random pharmacy compliance audits at Onco360/CareMed/ConnectMed360 pharmacy locations to ensure all pharmacy activities and operations are executed in compliance with state and/or federal regulations and laws governing pharmacy operations. This individual provides support to Onco360/CareMed/ConnectMed360 pharmacy operations teams in answering compliance and regulatory questions based around their needs. The Compliance Auditor shall develop and provide regular reports and updates regarding compliance matters to the...

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UW Health in Wisconsin is seeking a Compliance Analyst for a fully remote, full‑time role. The position involves auditing high-risk reimbursement issues and applying CPT/ICD10 coding knowledge to complex questions across professional and facility billing. You will collaborate with stakeholders, analyze data to identify risks, and conduct audits of billing providers and facilities. A Medical Coding Program or equivalent experience is required, with preferred CPC/CCS/CIC/COC/CPMA certifications. #J-18808-Ljbffr

Mascoma Bank is seeking an IT Audit & Compliance Analyst to join its Information Technology team in Hartford, Vermont. The role involves supporting risk, audit, and access governance programs, reviewing user access, and ensuring compliance with regulatory requirements. Ideal candidates will have a Bachelor's degree in a related field and 3-5+ years of IT audit experience. The position offers a salary range of $80,000 - $90,000 depending on experience, and emphasizes a commitment to diversity and inclusion. #J-18808-Ljbffr

Job Summary Position Summary: Under the direction of the Compliance Officer the main duties for this position include: analysis of professional coding and billing data, review of applicable regulations or guidelines and professional coding and billing audits. Duties/Responsibilities Analysis of coding and billing data, identification of trends and aberrations. Performance of routine and investigatory audits evaluating compliance with applicable laws, regulations, coding, and billing guidelines. Interpretation of coding, billing, and regulatory standards. Preparation and completion of audit reports including recommendations, education and corrective action. Knowledge, Skills and Abilities Strong computer skills specifically Microsoft Word and Microsoft Excel applications. Strong analytical, problem‑solving and time management skills. Expertise in report writing and oral communications. Ability to interpret regulations, payment and reimbursement systems, billing and coding...

Position Overview San Mateo County Health is seeking a well-qualified individual for the position of Electronic Health Record Analyst I/II – Resolute Professional Billing/Hospital Billing . The role supports Epic Resolute Professional Billing/Hospital Billing, prefers current Epic certification in Resolute Professional Billing, Resolute Hospital Billing, or Claims, and is located in South San Francisco or San Mateo, CA. Travel throughout the county is required, and the position is hybrid, with both on‑site and remote work based on business need. Primary Responsibilities Lead or participate in all phases of the Epic Professional Billing/Hospital Billing implementation lifecycle, including requirements gathering, design, build, testing, training, and go‑live support. Collaborate with cross‑functional teams to align system configurations with organizational goals and objectives. Configure and customize the Epic application to meet specific business requirements while adhering to...

Elevance Health is seeking a Coding Analyst Sr. to review, audit, and code medical records for reimbursement, training, and compliance. This role ensures accurate ICD-9 and CPT coding and collaborates with physicians to resolve documentation gaps. The position emphasizes education, auditing code accuracy, and cross-team collaboration. A HS diploma and CPC/CCS-P are required; CMS Risk Adjustment knowledge and CRC are preferred. Hybrid/virtual work with in-person sessions as needed. #J-18808-Ljbffr

Auditor (Financial Compliance Auditor Trainee) Department: COMP Compliance Division Employment Type: Full-Time Salary: $69,730.00/year with the potential to grow to $99,603.00/year over time. HR Analyst: David Brown Work Location: Baltimore City

Position Description & Qualifications The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program plays a vital role in safeguarding the integrity of the Medicare Fee-for-Service (FFS) program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and compliant with federal requirements. Supporting CMS’s obligations under the Payment Integrity Information Act (PIIA), the program uses statistically valid sampling and independent medical review of claims to identify improper payments and measure program performance. The insights generated through CERT enable CMS to strengthen accountability, improve healthcare delivery practices, and drive corrective actions that protect both beneficiaries and public funds. Through this work, the CERT program helps uphold transparency, stewardship, and trust in one of the nation’s most critical healthcare systems. This position ensures the supervision of the Medical Records...

A healthcare organization in New Mexico is seeking a remote Medical Coding Analyst I or II. This role focuses on coding inpatient and outpatient services, ensuring compliance with federal regulations while providing feedback on medical documentation. Candidates must have a high school diploma or GED and relevant certification in coding. The position offers a competitive salary, a sign-on bonus of $2,000, and comprehensive benefits, fostering well-being across New Mexico. #J-18808-Ljbffr

The University of New Mexico is hiring a detail-oriented Medical Coding Analyst for its Student Health & Counseling Clinic. In this full-time role, the analyst will coordinate fee processing for patient services, ensuring compliance with legal and procedural requirements. The position offers a pay range of $24.00 to $30.00 per hour based on experience and includes benefits such as medical, dental, vision, and life insurance. Applicants should have a high school diploma or GED and at least one year of relevant experience. Preferred qualifications include experience in medical coding and working with insurance claims. #J-18808-Ljbffr

Job Description Job Description Mb Staffing Services is seeking a detail-oriented Medicaid Coding & Reimbursement Analyst with direct experience in Medicaid billing, coding, claims review, and financial reconciliation. This role is ideal for professionals who understand the financial side of healthcare operations and are passionate about accuracy, compliance, and reporting. Key Responsibilities Review and analyze Medicaid claims, billing, and reimbursement data. Perform data entry and validate coding information for accuracy. Utilize ICD-10, CPT, HCPCS, and Medicaid-specific codes. Reconcile reports, payments, and billing discrepancies. Research and resolve claim denials and coding issues. Conduct audits and support compliance initiatives. Generate reports and analyze trends to improve billing accuracy. Review financial and operational data to identify variances and opportunities for improvement. Collaborate with providers and internal teams to ensure timely...

HIM/Medical Records Analyst/Coding Specialist Opportunity West Oaks Hospital has provided psychiatric care to the Houston area and surrounding communities for over four decades. Our 176-bed acute care facility is fully accredited and included a 16-bed residential treatment center for adult chemical dependency. We offer a broad range of behavioral health programs for children, adolescents and adults. Treatment is offered at multiple levels of care including inpatient, partial hospitalization and intensive outpatient. The hospital is easily accessible off the Southwest Freeway near the Galleria. West Oaks Hospital is seeking a dynamic and talented HIM/Medical Records Coding Specialist to join our team of compassionate, dedicated professionals. The HIM/Medical Records Coding Specialist will be responsible for assigning diagnostic and procedures codes and abstracts data to outpatient and/or inpatient encounters based upon documentation within the medical record while maintaining...