Auditor

• Perform and provide oversight for the Managed Care Plan’s DHCS auditing team
• Conduct and oversee initial and subsequent reviews of Primary Care Provider sites, including Facility Site Reviews and Medical Record Reviews
• Complete monthly audit assignments within established timelines with thorough, compliant documentation
• Review, analyze, and interpret DHCS All Plan Letters, legislative, statutory, regulatory, and contract language
• Develop implementation and communication plans for regulatory compliance and provider data requirements
• Audit SCAN-contracted and collaborative PCP offices serving Medi-Medi members under CMS, DHCS, and contractual requirements
• Provide auditing and post-audit documentation training, feedback, and improvement recommendations
• Conduct closing meetings and provide preliminary overviews of compliance audit results
• Support providers with corrective action plans, CAP monitoring, education, and compliance tools
• Respond to provider disagreements with audit findings and analyze submitted reports and correction requests
• Explain regulation interpretations and their application
• Conduct annual oversight projects, correspondence, project coordination, delegated compliance monitoring, status reporting, and regulatory update coordination
• Represent the Delegation Oversight Unit as a service delivery compliance subject matter expert
• Partner with Compliance on SCAN policies related to NCQA, DHCS, CMS, and other regulatory revisions
• Escalate longstanding non-compliance issues and identify barriers for supervisors/managers
• Educate providers on delegated claims processing and denial of claims involving member liability
• Review delegated administrator letters, Compliance Program processes, and data submissions for accuracy and compliance
• Maintain member privacy and confidential information
• Adhere to quality, compliance, and regulatory standards
• Support SCAN’s vision and goals and perform other duties as assigned

Network Compliance Auditor, FSR – RN

• Review encounters in prebill or retrospective workflows to validate coding profiles
• Evaluate applicable code sets, abstracted data elements, missed query opportunities, and related encounter data
• Perform quality coding reviews and audits within departmental productivity and accuracy standards
• Assist with re-bills and coding corrections after coding audits
• Prepare written summary reports of findings
• Coordinate and lead individual or small-group feedback sessions
• Communicate with internal and external stakeholders and peer departments
• Assist peer departments with production coding during staff shortages
• Improve data quality for reporting and research, accurate billing, and reimbursement
• Provide education sessions and facilitate round-table discussions
• Contribute content to the coding newsletter
• Review trends and data for opportunities
• Evaluate codes through data reports, validate findings, and recommend action plans
• Perform additional activities assigned by the Coding Supervisor

Coding Services Technology Auditor

• Execute and support IT internal controls assessments, IT audits, and investigations
• Design and implement automated, data-driven audit procedures using SQL, Python, or Cortex Code
• Partner with Engineering and Product teams to audit secure SDLC and CI/CD pipeline security
• Conduct compliance reviews against ISO 27001, ISO 42001, ISO 22301, and ISO 27017
• Lead cloud infrastructure audits across AWS, Azure, and GCP, focusing on IAM, encryption, and network security configurations
• Assess IT control deficiencies and audit findings
• Identify remediation procedures and compensating controls
• Assist with internal audit planning, fieldwork, close meetings, and reporting
• Help identify process improvements and recommend industry best practices
• Report to the Manager, IT Internal Audit

IT Auditor

• Participate in and lead internal audit-related assurance and consulting work
• Plan, conduct, document, and report audit results to determine the adequacy and effectiveness of controls
• Supervise and review moderate to moderately high-risk audit work performed by audit team members
• Evaluate audit team members' performance after each assignment with guidance
• Guide auditors to ensure quality expectations
• Typically supervise 1–4 employees on an assignment basis
• Define risk-based audit scope and objectives for District-focused audits
• Establish assignment time frames and budgets
• Develop new or revise existing audit programs
• Execute approved audit programs in accordance with established policies and standards
• Evaluate IT governance and risks
• Determine the effectiveness of controls related to information systems, operations, asset safeguarding, and compliance
• Identify, assess, and challenge the impact of audit exceptions
• Make recommendations and present explanations of issues to audit management and operating personnel
• Prepare written audit reports for business management
• Appraise corrective actions addressing previously reported findings
• Review follow-up work performed by other auditors
• Maintain knowledge of assigned liaison coverage areas
• Review and analyze pertinent data
• Assess the impact of changes
• Perform risk assessments for assigned areas
• Participate in nationwide System-wide assurance efforts related to FedCash Services and audit the NextGen Program
• Provide oversight and training to other audit teams across the US
• Contribute to the System-wide Cash Audit Competency Center through audit guidance and training programs

Lead IT Auditor

• Audit inpatient medical records to ensure clinical documentation supports billed and reimbursed conditions and DRGs
• Review Diagnosis Related Group (DRG) paid claims
• Analyze and audit claims using medical chart coding principles, clinical guidelines, and objectivity
• Apply advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
• Use audit tools, auditing workflow systems, and reference information to generate audit determinations and detailed audit findings letters
• Maintain accuracy and quality standards established by audit management
• Identify documentation and coding errors, including inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs)
• Suggest and develop concept, process improvement, and efficiency recommendations

DRG Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

• Execute audit programs within defined project timelines, addressing complex, high-risk areas with limited supervision
• Participate in planning operational audits and advisory projects, including regional audits, process reviews, and supplier audits
• Conduct process interviews and walkthroughs, document key attributes, and support junior auditors during planning
• Perform audit fieldwork in accordance with IIA standards
• Apply RACI frameworks, design testing attributes, complete work papers, and maintain quality and re-performance standards
• Contribute to audit methodologies and templates and recommend scope adjustments
• Identify control gaps, risks, and improvement opportunities
• Review methodology, evidence, and conclusions with the Project Manager
• Draft findings, consolidate reports, and present findings to stakeholders, project teams, and the CAE
• Support junior team members in issue resolution
• Maintain work papers, scope documentation, and project records in Optro
• Track management action plans and follow-up actions through audit closure in Optro
• Monitor remediation, validate corrective actions, gather evidence, and provide status updates to the Project Manager and CAE
• Lead small-scale operational audits or advisory projects
• Support SOX testing, IT projects, investigations, and other ad hoc cross-pillar initiatives

Senior Internal Auditor

• Review, audit, and code employee expense reports and supplier invoices for mathematical accuracy, policy adherence, and compliance with relocation tax regulations
• Create accurate and timely client invoices
• Manage expense inbox communications
• Review and audit multiple data resources for quality assurance
• Maintain business process documentation
• Perform other job-related duties as assigned
• Work closely with operations and supply chain teams on projects and tasks
• Report to the Director of Client Financial Solutions

Auditor jobs in California