Auditor

• Perform quality utilization reviews using evidence-based guidelines
• Approve medically necessary and appropriate care
• Prepare peer review reports, correspondence, addendums, and supplemental reviews
• Work directly with providers to identify the level, intensity, and duration of care
• Evaluate medical necessity for frequency, intensity, and length of required care
• Ensure reviews meet industry quality standards and mandated turnaround times
• Maintain knowledge of URAC and state and federal regulatory requirements
• Maintain accurate utilization review records in the appropriate database
• Direct Customer Service Representatives to ensure timely delivery of determination letters
• Assist with client complaints and quality assurance issues
• Ensure compliance with ERISA, URAC, and other applicable guidelines
• Provide management with insight on compliance concerns
• Participate in company meetings, training activities, and continuing education
• Perform other assigned duties

Utilization Review Nurse Auditor

• Perform quality utilization review and approve medically necessary and appropriate care according to evidence-based guidelines and criteria
• Complete peer review reports, correspondence, addendums, and supplemental reviews
• Work directly with providers to identify level, intensity, and duration of care
• Document findings and evaluate medical necessity for frequency, intensity, and length of care
• Ensure reviews meet industry standards and required client, federal, state, or URAC turnaround times
• Maintain knowledge of URAC and other regulatory requirements
• Maintain accurate utilization review records in the appropriate database
• Direct Customer Service Representatives to ensure timely delivery of determination letters
• Assist with client complaints and quality assurance issues
• Provide management with insight on compliance concerns
• Participate in company meetings, training activities, and continuing education
• Perform other assigned duties

• Execute the Clinical audit program, including scheduling, planning, reporting, and resolution of Clinical audits
• Ensure alignment with RDQA policies and procedures
• Contribute to development and implementation of the Clinical QA quality system
• Provide advice and support on GCP and quality topics to business partners
• Evaluate Clinical processes through audits and QA oversight activities to assure quality and compliance
• Lead and participate in Clinical Audit scheduling, planning, and conduct activities
• Conduct investigator clinical site, process, system, and Affiliate audits
• Communicate audit results orally and in writing within target timeframes
• Review and approve Corrective Action Plans and track actions to completion
• Contribute to development and implementation of systems and processes supporting global quality assurance requirements
• Support maintenance or development of Quality standards relating to Clinical audit
• Contribute to continuous improvement initiatives and projects
• Participate in and support GCP inspections as required
• Provide GCP regulatory support and consultation to RDQA and business partners
• Promote continuous education on quality, clinical guidelines, and regulations

Auditor, RDQA Clinical Quality Audit

• Prepare daily Restaurant Revenue Report data by auditing Micros tapes/journals
• Break down revenue, covers, server tips paid out, and settlements by type and cashier
• Run audit reports and journals
• Make corrections and adjustments and handle computer problems during the shift
• Input revenue, expenses, and allowances into the PC to generate daily reports
• Balance revenue and settlement accounts nightly
• Maintain files and reset the system for next-day operations
• Complete and properly file reports and backup vouchers
• Distribute copies of documents and daily reports to A/R, A/P, Payroll, and other appropriate personnel
• Review and correct discrepancies in the Front Desk System
• Coordinate with the front desk and restaurants/bars closing to facilitate file maintenance and system resets
• Greet customers and provide accurate information about outlet hours and local attractions
• Complete guest registration and retrieve information using a computer system
• Select rooms based on guest needs
• Code electronic keys, certificates, and coupons
• Verify and imprint credit cards for authorization
• Handle cash, make change, and balance the assigned house bank
• Accept and record vouchers, travelers’ checks, and other forms of payment
• Perform moderately complex arithmetic using a calculator
• Post charges to guest rooms and house accounts
• Answer the telephone, input and retrieve guest messages, and communicate message content
• Retrieve mail, small packages, and facsimiles for customers
• Perform other duties requested by the Controller and Assistant Controller

Night Auditor, Part Time

• Execute the Clinical audit program, including scheduling, planning, reporting, and resolution of Clinical audits
• Ensure alignment with RDQA policies and procedures
• Contribute to the development and implementation of the Clinical QA quality system
• Provide advice and support on GCP and quality topics to business partners
• Evaluate Clinical processes through audits and QA oversight activities to assure quality and compliance
• Lead and participate in scheduling, planning, and conducting investigator clinical site, process, system, and Affiliate audits
• Communicate audit results orally and in writing within target timeframes
• Review and approve Corrective Action Plans and track actions to completion
• Advance the AbbVie Quality System through development and implementation of systems and processes
• Support maintenance or development of Quality standards relating to Clinical audit
• Contribute to continuous improvement initiatives and projects
• Participate in and support GCP inspections as required
• Provide GCP regulatory support and consultation to RDQA and business partners
• Promote continuous education on quality, clinical guidelines, and regulations

• Perform comprehensive coding audits across all professional services at VMG
• Ensure coding accuracy, compliance, and consistency
• Support service-line transitions, vendor oversight, and quality validation
• Align with a Coding Educator to coordinate education and quality improvement efforts
• Monitor coding quality metrics, audit outcomes, and performance indicators
• Communicate findings, recommendations, and financial impact to providers, leadership, and operational stakeholders
• Develop corrective action plans and collaborate with coding educators, operational leaders, and providers
• Evaluate outsourced coding vendor performance and monitor SLAs
• Ensure adherence to quality and compliance standards
• Manage multiple audits, projects, and deadlines simultaneously
• Present complex information to diverse audiences

Auditor jobs in New Jersey

Utilization Review Nurse Auditor

Utilization Review Nurse Auditor

Auditor, RDQA Clinical Quality Audit

Night Auditor, Part Time

Auditor, RDQA Clinical Quality Audit

Coding Auditor, Health Information Management