Current jobs related to Clinical Auditor Manager - St Louis, Missouri - SSM Health

  • Clinical Auditor Manager

    4 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Clinical Auditor Manager Job SummarySSM Health is seeking a highly skilled Clinical Auditor Manager to join our team. As a key member of our Care Transformation department, you will be responsible for ensuring the daily management of auditing, monitoring of processes, reporting, and outcomes to ensure compliance with regulatory requirements and standards are...

  • Clinical Auditor

    3 weeks ago

    St Louis, Missouri, United States Zelis Healthcare Full time

    Job Summary:The Clinical Auditor will be responsible for conducting in-depth reviews of medical claims to ensure compliance with accepted medical guidelines and clinical criteria. This role requires a strong understanding of audit techniques, identification of revenue opportunities, and financial negotiation with providers. The ideal candidate will have 3-5...

  • Senior Technology Auditor

    3 weeks ago

    St Louis, Missouri, United States Edward Jones Full time

    Job OverviewAt Edward Jones, we're seeking a highly skilled Senior Technology Auditor to join our team. As a Senior Technology Auditor, you'll play a critical role in identifying and reducing risks within the firm. Your focus will be on providing assurance on home office systems and technology supporting our 18,000 branch teams.ResponsibilitiesAs a Senior...

  • Senior Technology Auditor

    4 weeks ago

    St Louis, Missouri, United States Edward Jones Full time

    Unlock Your Potential as a Senior Technology Auditor at Edward JonesAre you passionate about making a meaningful impact in the world of technology and finance? Do you thrive in a collaborative environment where innovation and expertise come together? If so, we invite you to explore the exciting opportunity of a Senior Technology Auditor at Edward Jones.About...

  • Senior Technology Auditor

    3 weeks ago

    St Louis, Missouri, United States Edward Jones Full time

    At Edward Jones, we are seeking a highly skilled Senior Technology Auditor to join our Internal Audit team. This role will be responsible for performing engagement-level assessments of business and technology risks, developing audit scope, and planning all phases of the audit engagement.The ideal candidate will have a strong background in technology and...

  • Compliance Auditor

    4 weeks ago

    St Louis, Missouri, United States Certara USA, Inc. Full time

    Job Title: Compliance, Internal AuditorAbout the Role:Certara USA, Inc. is seeking a highly skilled Compliance, Internal Auditor to join our team. As a key member of our Compliance Standards & Data Privacy organization, you will play a critical role in ensuring the effective implementation and verification of our compliance program(s).Key...

  • Senior IT Auditor

    4 weeks ago

    St Louis, Missouri, United States Enterprise Bank & Trust Full time

    Job SummaryEnterprise Bank & Trust is seeking a skilled IT Auditor to join our team. As a Senior IT Auditor, you will be responsible for executing risk-based IT internal audits in accordance with the annual audit plan, as well as assisting with other audit matters and projects.Key ResponsibilitiesAssist with the development of Information Systems Audit plans...

  • Staff Auditor

    4 weeks ago

    St Louis, Missouri, United States Emerson Group Full time

    Job Title: Staff AuditorEmerson is seeking a highly skilled Staff Auditor to join our Internal Audit Team in St. Louis, Missouri. As a Staff Auditor, you will play a critical role in ensuring the accuracy and reliability of our financial statements and controls.Key Responsibilities:Perform financial audits and Sarbanes-Oxley (SOX 404) control reviews as part...

  • Parking Lot Auditor

    4 weeks ago

    St Louis, Missouri, United States Parking Management Services Full time

    Parking Lot Auditor / Lot Attendant Job DescriptionParking Management Company (PMC) is seeking a dedicated individual for the position of Parking Lot Auditor / Lot Attendant. This role involves monitoring parking lots and garages, performing operational duties as required, and providing excellent customer service.Responsibilities:Monitor parking lots and...

  • Compliance Auditor

    3 weeks ago

    St Louis, Missouri, United States Certara USA, Inc. Full time

    Job SummaryCertara USA, Inc. is seeking a highly skilled Compliance Internal Auditor to join our team. As a Compliance Internal Auditor, you will be responsible for assisting with the implementation and verification of Certara's compliance program(s), including correlating audit management and customer touchpoints.Key Responsibilities• Work with business...

  • Staff Auditor Intern

    4 weeks ago

    St Louis, Missouri, United States Emerson Group Full time

    Job DescriptionEmerson is seeking a highly motivated and detail-oriented Staff Auditor Intern to join our team for a summer internship. As a Staff Auditor Intern, you will have the opportunity to work on financial audits and Sarbanes-Oxley (SOX 404) control reviews as part of an audit team under the supervision of an Audit Senior.Responsibilities:Perform...

  • Senior Technology Auditor

    4 weeks ago

    St Louis, Missouri, United States Edward Jones Full time

    Transform Your Career with Edward JonesAre you looking for a meaningful career where you can make a difference? Edward Jones is the perfect place for you to grow and thrive.About the RoleAs a Senior Technology Auditor, you will play a critical role in identifying and reducing risks within the firm. You will work closely with the audit team to provide...

  • IT Program Auditor

    4 weeks ago

    St Louis, Missouri, United States Life Cycle Engineering Full time

    Job Summary:As an IT Program Auditor at Life Cycle Engineering, you will play a critical role in providing cybersecurity support to the National Geospatial-Intelligence Agency (NGA) in St. Louis, MO. Your primary responsibility will be to conduct evaluations of IT programs or their individual components to determine compliance with published standards.Key...

  • Clinical Specialist Manager

    2 months ago

    St Louis, Missouri, United States Fujifilm Corporation Full time

    Job Title: Clinical Specialist ManagerThis is a challenging and rewarding role that requires a unique blend of clinical expertise, business acumen, and leadership skills. As a Clinical Specialist Manager, you will be responsible for supporting the attainment of annual regional sales goals through the direct management of Clinical Specialists in assigned...

  • Clinical Specialist Manager

    4 weeks ago

    St Louis, Missouri, United States Fujifilm Corporation Full time

    Job Summary:This role is responsible for supporting the attainment of annual regional sales goals through the direct management of Clinical Specialists in assigned regions. The Manager, Clinical Specialists partners with Regional Sales Managers to set successful transition strategies for customer relationships from Sales to the Specialist Team after deal...

  • Clinical Specialist Manager

    4 weeks ago

    St Louis, Missouri, United States Fujifilm Corporation Full time

    Job Summary:This Manager, Clinical Specialists role is responsible for supporting the attainment of annual regional sales goals through the direct management of Clinical Specialists in assigned regions. The ideal candidate will reside in one of the following locations: St. Louis, Omaha, Birmingham, Oklahoma City, San Antonio, Dallas, Houston, Forth Worth, or...

  • Clinical Specialist Manager

    2 months ago

    St Louis, Missouri, United States Fujifilm Corporation Full time

    Job Title: Manager, Clinical SpecialistsJob Summary:This role is responsible for supporting the attainment of annual regional sales goals through the direct management of the Clinical Specialists in assigned region. The ideal candidate would reside in one of the following locations: St. Louis, Omaha, Birmingham, Oklahoma City, San Antonio, Dallas, Houston,...

  • Clinical Case Manager

    3 weeks ago

    St Louis, Missouri, United States People's Family of Corporations Full time

    Job Title: Clinical Case ManagerAt People's Family of Corporations, we are seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will be responsible for conducting initial assessments with clients, maintaining case management responsibilities, and participating in staff training to learn skills such as interviewing,...

  • Clinical Specialist Manager

    2 months ago

    St Louis, Missouri, United States Fujifilm Corporation Full time

    Job Summary:This role is responsible for supporting the attainment of annual regional sales goals through the direct management of Clinical Specialists in assigned regions. The ideal candidate will reside in one of the following locations: St. Louis, Omaha, Birmingham, Oklahoma City, San Antonio, Dallas, Houston, Forth Worth, or New Orleans.Key...

  • Clinical Care Manager

    4 weeks ago

    St Louis, Missouri, United States atsu Full time

    Job Title: Clinical Care ManagerA.T. Still University's Missouri School of Dentistry and Oral Health (ATSU-MOSDOH) is seeking a full-time non-exempt Clinical Care Manager on the St. Louis, MO campus. The Clinical Care Manager will oversee D3/D4 students' clinical progress, productivity, utilization of time, and coordinate the treatment of active patients as...

Clinical Auditor Manager

2 months ago

St Louis, Missouri, United States SSM Health Full time
Job Summary

As a Clinical Auditor Manager, you will play a critical role in ensuring the daily management of auditing, monitoring of processes, reporting, and outcomes to ensure Care Transformation is compliant with regulatory requirements and standards are maintained.

Key Responsibilities
  • Perform clinical audits within Care Transformation operations by supporting the Clinical Documentation Improvement, Utilization Management, Status Review, and Case Management departments.
  • Standardize policies, procedures, and reporting for all auditing procedures.
  • Review patient medical record documentation related to Clinical Documentation Improvement, Utilization Management, and compare against medical bills, claims, and revenue reports.
  • Participate in training of specific areas of focus by tailoring to specific needs identified within auditing findings.
  • Utilize auditing data, along with data analysts/liaisons, to improve risk adjustment measures and denial management processes within department.
  • Resolve inquiries from internal and external sources to reconcile accounts accurately and within compliance guidelines.
  • Ensure compliance with government and billing guidelines by reviewing and splitting or combining claims per clinical/billing guidelines.
  • Enhance net revenue by splitting charges that should be presented on separate claims to capture entitled revenue.
  • Perform other duties as assigned.
Requirements
  • Graduate of accredited school of nursing or education equivalency for licensing.
  • 7 years of relevant experience in clinical auditing.
  • Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) or Registered Nurse (RN) Issued by Compact State or Registered Nurse (RN) - Missouri Division of Professional Registration or Registered Nurse (RN) Issued by Compact State or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) or Registered Nurse (RN) Issued by Compact State or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services.
Benefits

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

We offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).

Our voluntary benefit offered through DailyPay provides eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

We provide upfront tuition coverage through FlexPath Funded for eligible team members.