Top 35 Auditor nurse Jobs in Massachusetts

RN Readmission Manager, Payment Integrity
Centene Corporation —Massachusetts
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
7d
Internal Auditor, Finance & Operations
GE Vernova —Cambridge, MA
- $104,500 - $174,000 a year
- Full-time
- CPA
- Pass drug screening
- Mid-level
- Paid parental leave
- Paid holidays
Clinical Claim Review RN
Optum —Boston, MA
- $29 - $52 an hour
- 8 hour shift
- Remote
- 18 years or older
- RN License
- Customer service
- On-the-job training
5d
Senior Auditor - Digital Technology & Cybersecurity
GE Vernova —Cambridge, MA
- $119,100 - $198,500 a year
- Full-time
- Hybrid work
- Writing skills
- Pass drug screening
- Mid-level
- Paid parental leave
- Paid holidays
Staff Auditor - Digital Technology & Cybersecurity
GE Vernova —Cambridge, MA
- $104,500 - $174,000 a year
- Full-time
- 6 years
- Computer Science
- Pass drug screening
- Paid parental leave
- Paid holidays
Clinical Audit Response Specialist
Dana-Farber Cancer Institute —Boston, MA
- $110,200 - $122,300 a year
- Full-time
- Nursing
- RN License
- 5 years
Senior Reimbursement Analyst
Beth Israel Lahey Health —Charlestown, MA
- $83,200 - $111,904 a year
- Full-time
- Senior level
2d
Senior Financial Analyst- Reimbursement
Beth Israel Lahey Health —Charlestown, MA
- $83,200 - $111,904 a year
- Full-time
- Senior level
8d
Corporate Controller
Beth Israel Lahey Health —Charlestown, MA
- $231,000 - $275,000 a year
- Full-time
- Management
- CPA
- Office
Staff Accountant
Beth Israel Lahey Health —Charlestown, MA
- $58,240 - $78,624 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Finance
- Analysis skills
Payroll Manager
NeighborHealth —Revere, MA
- $111,280 - $174,720 a year
- Online Application
- Background check
- Microsoft Excel
- Management
- 403(b) matching
- 401(k)
Senior Reimbursement Analyst
Merrimack Health —Lawrence, MA
- $43.28 - $64.93 an hour
- Full-time
- Mid-level
- Office
- 3 years
- Free parking
- Paid time off
Accountant II
Mass General Brigham Incorporated —Somerville, MA
- $75,754.02 - $92,570.40 a year
- Full-time
- Customer service
- Word processing
- ERP systems
- Opportunities for advancement
Quick Apply
22h
Clinical Compliance Director
VITRA Health —Boston, MA
- Full-time
- Nursing
- RN License
- 5 years
- Paid holidays
- Disability insurance
Quick Apply
4d
Hematology Lead Technologist – 37.5 hours/week, day shift
Beth Israel Lahey Health —Newburyport, MA
- $40.45 - $54.43 an hour
- Full-time
- Acute care
- Microsoft Excel
- Microsoft Outlook
14d
Accountant Lead
Mass General Brigham Incorporated —Somerville, MA
- $79,560.00 - $115,720.80 a year
- Full-time
- Remote
- Microsoft Outlook
- CPA
- Customer service
- Opportunities for advancement
Quick Apply
1d
HIM Audit Coordinator
Beth Israel Lahey Health —Burlington, MA
- $20.00 - $26.92 an hour
- Full-time
- Microsoft Word
- Nursing
- Anatomy knowledge
Chief Financial Officer
Chestnut Hill Benevolent Association —Boston, MA
- Full-time
- CPA
- Office
- GAAP
Health Information Management Associate (40hrs, On-Site)
Beth Israel Lahey Health —Woburn, MA
- $20.00 - $26.92 an hour
- Full-time
- Hospital
- HIPAA
- Office
Lead Health Information Management Audit Specialist (On-Site)
Beth Israel Lahey Health —Burlington, MA
- $21.00 - $28.26 an hour
- Full-time
- Nursing
- Anatomy knowledge
- Microsoft Excel

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auditor nurse jobs near massachusetts

RN Readmission Manager, Payment Integrity

Centene Corporation -
Massachusetts

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Job Details

Full-time
$87,700 - $157,800 a year
7 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Medical claims processing software
Healthcare team management
Healthcare reimbursement methods
Healthcare coding investigations
Documentation reviews
DRG

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

A Licensed RN paired with a Coding Credential is the candidate this team is seeking for this position that will lead and oversee PI initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy. You will lead a team focused on expanded readmission reviews allowing CNC to ensure payment accuracy as well as alignment with internal policies and regulatory requirements. Experience Required for all RN's with Coding Credentials applying:

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.

Position Purpose:
Manages a team of auditors and clinical professionals and is accountable for audit quality, consistency, and overall program performance for potentially preventable readmissions. Oversees payer readmission review programs to ensure accurate, compliant determinations and achievement of payment integrity objectives. This role directs the identification and validation of potentially preventable readmissions while supporting appropriate reimbursement under MS-DRG and APR-DRG methodologies. Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices.

Lead and oversee Payment Integrity initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy, ensuring alignment with established objectives, internal policies, and regulatory requirements.
Collaborate with Health Plans, Medical Economics, Finance, Compliance, Legal, Provider Relations, and Technology teams to support the design, execution, and ongoing monitoring of readmission and DRG-related Payment Integrity strategies.
Monitor program performance against defined metrics, financial targets, and operational benchmarks, using trend analysis to identify risks, variances, and opportunities for improvement.
Provide leadership and operational oversight to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, consistency, timeliness, and adherence to established review standards.
Ensure compliance with federal and state regulations, managed care organization requirements, contractual obligations, and internal policies governing Payment Integrity and audit activities.
Prepare and present reports, analyses, and performance summaries to leadership and key stakeholders, highlighting audit outcomes, trends, and actionable recommendations.
Identify process gaps, operational risks, and control weaknesses, and implement or recommend corrective actions to improve quality, efficiency, and program effectiveness.
Lead, coach, and develop team members by setting clear expectations, promoting accountability, and fostering a culture of collaboration, quality, and continuous improvement.
Serve as a subject matter expert for Payment Integrity practices within assigned scope, providing guidance on readmission review methodology, audit standards, and reimbursement considerations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or a related field required; an additional four (4) years of directly related experience may be considered in lieu of a degree.

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.
Experience working with payer claims systems preferred.
Demonstrated experience supporting government programs, regulatory compliance, or audit activities preferred.
Project management experience preferred.
Experience partnering with external vendors supporting Payment Integrity audit, recovery, or edit programs preferred.
Inpatient hospital documentation improvement experience preferred.

Master’s degree preferred.

License/Certification: Active Health Information Management or coding credentials required, such as RHIT, RHIA, CCS, CIC, or CCDS or Registered Nurse licensure or higher clinical qualification, in combination with a coding credential, required.

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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Refine Your Search

auditor nurse jobs in massachusetts

RN Readmission Manager, Payment Integrity

Internal Auditor, Finance & Operations

Clinical Claim Review RN

Senior Auditor - Digital Technology & Cybersecurity

Staff Auditor - Digital Technology & Cybersecurity

Clinical Audit Response Specialist

Senior Reimbursement Analyst

Senior Financial Analyst- Reimbursement

Corporate Controller

Staff Accountant

Payroll Manager

Senior Reimbursement Analyst

Accountant II

Clinical Compliance Director

Hematology Lead Technologist – 37.5 hours/week, day shift

Accountant Lead

HIM Audit Coordinator

Chief Financial Officer

Health Information Management Associate (40hrs, On-Site)

Lead Health Information Management Audit Specialist (On-Site)

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