Top 109 Compliance auditor Jobs in Nashville, Tn

Claims Auditor- Remote
American Health Plans —Franklin, TN
- Remote
- Mid-level
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Sr Compliance Specialist
Shearwater Health —Nashville, TN
- Full-time
- Remote
- Bachelor of Science
- Analysis skills
- Bachelor's degree
Quick Apply
SOX Auditor
Parallon —Nashville, TN
- Full-time
- Remote
- Mid-level
- 3 years
- Employee stock purchase plan
- Disability insurance
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9d
AUDITOR 3 - 07142026-78947
Health —Nashville, TN
- $4,562 - $6,825 a month
- Full-time
- CPA
- Writing skills
- Mid-level
Senior Internal Auditor - Hybrid
The Cigna Group —Nashville, TN
- Online Application
- Microsoft Excel
- CPA
- Mid-level
Compliance Analyst
Quorum Health Corporation —Brentwood, TN
- Remote
- HIPAA
- Mid-level
- Analysis skills
- Loan repayment program
- Health insurance
Quick Apply
4d
INTERNAL AUDITOR I
Dollar General —Goodlettsville, TN
- Full-time
- CPA
- Merchandising
- Office
Legislative Auditor: TennCare
Tennessee Comptroller of the Treasury —Nashville, TN
- Full-time
- Mid-level
- Office
- Bachelor's degree
- 401(k)
- Flexible schedule
Staff Internal Auditor
Acadia Healthcare —Franklin, TN
- Full-time
- Microsoft Excel
- CPA
- English
- Health insurance
- Dental insurance
AUDITOR 2 - DCS INTERNAL AUDIT - DAVIDSON - 79634
Children's Services —Nashville, TN
- $48,684 - $73,188 a year
- Full-time
- Background check
- Mid-level
- Office
4d
UNEMPLOYMENT BENEFITS AUDITOR - 07282026-79581
Labor & Workforce Development —Nashville, TN
- $3,631 a month
- Full-time
- Customer service
- Writing skills
- Mid-level
4d
Auditor
TN Department of Children's Services —Nashville, TN
- $4,057 - $5,078 a month
- Online Application
- Mid-level
- Office
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
5d
Sr. Compliance Analyst
PTS Advance —Brentwood, TN
- Mid-level
- 3 years
- Analysis skills
Quick Apply
11d
Senior Auditor - Nashville, TN/Hybrid
Software Technology Inc —Nashville, TN
- Hybrid work
- 6 years
- CPA
- Finance
Quick Apply
Coding Quality Auditor
Houston Methodist —Tennessee
- Full-time
- Anatomy knowledge
- English
- Mid-level
Junior Internal Auditor
Metro Nashville Airport Authority —Nashville, TN
- $25.35 - $43.62 an hour
- Online Application
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Disability insurance
Quick Apply
Research Billing Compliance Specialist - Vanderbilt Ingram Cancer Center
Vanderbilt Health —Nashville, TN
- Full-time
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Health insurance
Specialist, Risk and Compliance Services (Center of Excellence)
Deloitte —Nashville, TN
- $63,000 - $116,000 a year
- Full-time
- Microsoft Outlook
- Research
- Mid-level
13d
Night Auditor
Noelle, Nashville, TN, US —Nashville, TN
- Part-time
- Accounting
- Entry level
- Loan repayment program
- Health insurance
Quick Apply
Senior Internal Auditor
FirstBank —Nashville, TN
- Full-time
- CPA
- Office
- Finance
Quick Apply

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compliance auditor jobs near nashville, tn

Claims Auditor- Remote

American Health Plans -
Franklin, TN

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Job Details

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Referral program

Qualifications

Medicare
Managed care
Managed care organization experience
CMS
Regulatory compliance in claims processing
Medical claims processing software
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid
Quality audits
Insurance (Financial sectors)
Healthcare claims compliance audits
Audit support
Healthcare coding compliance audits

Full Job Description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com (https://amhealthplans.com/).

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleMedicine 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts
Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
Work assigned claim projects to completion
Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
Maintain production and quality standards as established by management
Participate in and support ad-hoc audits as needed
Other duties as assigned

JOB REQUIREMENTS:

Proficient in processing/auditing claims for Medicare and Medicaid plans
Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
Current experience with both Institutional and Professional claim payments
Knowledge of automated claims processing systems
Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

Experience:
- Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
- Two (2) years’ experience in managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
- Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
License/Certification(s):
- Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Quick Apply

Refine Your Search

compliance auditor jobs in nashville, tn

Claims Auditor- Remote

Sr Compliance Specialist

SOX Auditor

AUDITOR 3 - 07142026-78947

Senior Internal Auditor - Hybrid

Compliance Analyst

INTERNAL AUDITOR I

Legislative Auditor: TennCare

Staff Internal Auditor

AUDITOR 2 - DCS INTERNAL AUDIT - DAVIDSON - 79634

UNEMPLOYMENT BENEFITS AUDITOR - 07282026-79581

Auditor

Sr. Compliance Analyst

Senior Auditor - Nashville, TN/Hybrid

Coding Quality Auditor

Junior Internal Auditor

Research Billing Compliance Specialist - Vanderbilt Ingram Cancer Center

Specialist, Risk and Compliance Services (Center of Excellence)

Night Auditor

Senior Internal Auditor

I want to receive the latest job alert for compliance auditor in nashville, tn

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