Clinical Auditor Manager

4 weeks ago

St Louis MO USA, United States SSM Health Full time
Job Summary

SSM 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 compliance with regulatory requirements and maintaining high-quality standards in our clinical auditing processes.

Key Responsibilities
  • Develop and maintain auditing tools, procedures, and reporting for all areas of Care Transformation operations.
  • Perform operational and compliance audits, adhering to regulatory requirements.
  • Create and standardize policies, procedures, and reporting for all auditing procedures.
  • Review patient medical records and compare documentation against medical bills, claims, and revenue reports.
  • Participate in training and development of staff, tailoring to specific needs identified within auditing findings.
  • Utilize auditing data to improve risk adjustment measures and denial management processes.
  • Resolve inquiries from internal and external sources, ensuring accurate and compliant account reconciliation.
  • Ensure compliance with government and billing guidelines, reviewing and splitting or combining claims as necessary.
  • Improve claim submission processes by reviewing, researching, resolving, and trending claim issues in a timely manner.
Requirements
  • Graduate of an accredited school of nursing or equivalent education for licensing.
  • 7 years of relevant experience in clinical auditing.
Professional Licenses and Certifications
  • Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR).
  • Registered Nurse (RN) - Missouri Division of Professional Registration.
  • Registered Nurse (RN) - Oklahoma Board of Nursing (OBN).
  • Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services.
Work Environment

SSM Health is an equal opportunity employer, committed to diversity and inclusion. We offer a comprehensive benefits package, including paid parental leave, flexible payment options, and upfront tuition coverage.

  • Clinical Auditor Manager

    3 weeks ago

    St. Louis, MO, USA, United States SSM Health Full time

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

  • Clinical Auditor Manager

    7 days ago

    St. Louis, MO, USA, United States SSM Health Full time

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

  • Clinical Auditor Manager

    2 weeks ago

    St. Louis, MO, USA, United States SSM Health Full time

    Care Transformation Clinical Auditor ManagerAbout the Role:SSM Health is seeking a highly skilled Clinical Auditor Manager to join our Care Transformation team. As a key member of our team, you will be responsible for ensuring the daily management of auditing, monitoring of processes, reporting, and outcomes to ensure Care Transformation is compliant with...

  • Clinical Auditor Manager

    3 weeks ago

    St. Louis, MO, USA, United States SSM Health Full time

    Care Transformation Clinical Auditor ManagerAbout the Role:SSM Health is seeking a highly skilled Clinical Auditor Manager to join our Care Transformation team. As a key member of our team, you will be responsible for ensuring the daily management of auditing, monitoring of processes, reporting, and outcomes to ensure Care Transformation is compliant with...

  • Clinical Auditor Manager

    2 weeks ago

    St Louis, Missouri, United States SSM Health Full time

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

  • Clinical Auditor Manager

    3 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    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 compliance with regulatory requirements and maintaining high standards of care.Key ResponsibilitiesPerform clinical audits within Care Transformation operations, including...

  • Clinical Auditor Manager

    2 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesPerform clinical audits within Care Transformation operations by...

  • Clinical Auditor Manager

    4 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesPerform clinical audits within Care Transformation operations by...

  • Clinical Auditor Manager

    3 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesPerform clinical audits within Care Transformation operations by...

  • Clinical Auditor Manager

    4 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesCreates and maintains auditing tools, procedures, and reporting for all...

  • Clinical Auditor Manager

    3 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesCreates and maintains auditing tools, procedures, and reporting for all...

  • Clinical Auditor Manager

    2 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesCreates and maintains auditing tools, procedures, and reporting for all...

  • Clinical Auditor Manager

    3 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesCreates and maintains auditing tools, procedures, and reporting for all...

  • Clinical Auditor Manager

    6 days ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs a Clinical Auditor Manager at SSM Health, you will be responsible for 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 ResponsibilitiesCreates and maintains auditing tools, procedures, and reporting...

  • Clinical Auditor Manager

    3 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs 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 ResponsibilitiesCreate and maintain auditing tools, procedures, and reporting for all...

  • Clinical Auditor Manager

    4 weeks ago

    St Louis, Missouri, United States SSM Health Full time

    Job SummaryAs a Clinical Auditor Manager at SSM Health, 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 ResponsibilitiesCreate and maintain auditing tools, procedures, and...

  • Clinical Auditor Manager

    4 weeks ago

    Saint Louis, United States SSM Health Full time

    Job SummaryWe are seeking a highly skilled Clinical Auditor Manager to join our team at SSM Health. As a key member of our Care Transformation department, you will be responsible for ensuring compliance with regulatory requirements and maintaining high standards of care.Key ResponsibilitiesPerform clinical audits within Care Transformation operations,...

  • Staff Auditor Intern

    2 hours ago

    St. Louis, MO, USA, United States Emerson Group Full time

    About the RoleWe are seeking a highly motivated and detail-oriented Staff Auditor Intern to join our team in St. Louis, Missouri. 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.ResponsibilitiesPerform audits...

  • RN-Clinical Auditor Manager, Care Transformation

    4 weeks ago

    st. louis, United States SSM Health Full time

    It's more than a career, it's a callingMO-SSM Health Mission HillWorker Type:RegularJob Highlights:RN-Clinical Auditor Manager, Care Transformation - Case Management and Social Work7 year’s relevant experience in clinical auditing is required.Ideal candidate has experience and knowledge of inpatient/acute Case Management. Job Summary:Ensures the daily...

  • RN-Clinical Auditor Manager, Care Transformation

    4 weeks ago

    st. louis, United States SSM Health Full time

    It's more than a career, it's a callingMO-SSM Health Mission HillWorker Type:RegularJob Highlights:RN-Clinical Auditor Manager, Care Transformation - Case Management and Social Work7 year’s relevant experience in clinical auditing is required Job Summary:Ensures the daily management of auditing, monitoring of processes, reporting, and outcomes to ensure...