LogoFresh Jobs Ahead
SCAN
SCAN
1,001 – 5,000 Employees
H1B Visa SponsorB2CHealthcareHealthcare Insurance
SCAN is a mission-driven healthcare organization dedicated to helping older adults live healthier, more independent lives. Founded in 1977, it combines healthcare insurance with evidence-based, patient-centered services, including in-home and virtual primary care, caregiver support, programs for homebound adults, and specialized care for vulnerable populations. SCAN also partners with and invests in organizations developing new care models and resources for aging at home.
LinkedIn
Company Jobs

Network Compliance Auditor, FSR (RN) – California Remote

Lead DHCS and CMS compliance audits for California primary care provider sites as a registered nurse auditor. Help SCAN advance its nonprofit mission to improve care for older adults.

USUnited StatesCACalifornia
$38 – $55 / hour
RemoteFull-timeJuniorMiddleEnglish RequiredAuditor

Description

  • Lead and oversee the Managed Care Plan’s DHCS auditing team
  • Conduct initial and follow-up reviews of primary care provider sites, including Facility Site Reviews and Medical Record Reviews
  • Complete monthly audits on schedule with thorough, compliant documentation
  • Interpret DHCS All Plan Letters, legislative provisions, statutes, regulations, and contract language
  • Create implementation and communication plans for regulatory compliance and provider data requirements
  • Audit SCAN-contracted and collaborative PCP offices serving Medi-Medi members under CMS, DHCS, and contractual requirements
  • Train teams on audit and post-audit documentation, provide feedback, and recommend improvements
  • Lead closing meetings and present preliminary compliance audit results
  • Help providers develop corrective action plans, monitor CAPs, deliver education, and use compliance tools
  • Address provider disputes over audit findings and evaluate submitted reports and correction requests
  • Explain regulatory interpretations and how they apply
  • Manage annual oversight initiatives, correspondence, project coordination, delegated compliance monitoring, status reporting, and regulatory update coordination
  • Serve as a service delivery compliance subject matter expert for the Delegation Oversight Unit
  • Collaborate with Compliance on SCAN policies addressing NCQA, DHCS, CMS, and other regulatory changes
  • Escalate persistent non-compliance and identify obstacles for supervisors and managers
  • Educate providers about delegated claims processing and claim denials involving member liability
  • Review delegated administrator letters, Compliance Program processes, and data submissions for accuracy and compliance
  • Protect member privacy and confidential information
  • Follow quality, compliance, and regulatory standards
  • Support SCAN’s vision and goals and complete other assigned duties

Requirements

  • Hold a current, active California Registered Nurse license in good standing
  • Have at least two years of clinical experience, including experience such as emergency or acute care nursing
  • Associate degree in Nursing
  • DHCS-CSR certification is preferred
  • Previous auditing experience is preferred
  • Work effectively both independently and as part of a team
  • Have beginning to working knowledge of the subject matter
  • Demonstrate basic technical skills relevant to the functional area
  • Apply basic problem-solving skills
  • Communicate effectively and work well with others
  • Use analytical, critical-thinking, problem-solving, and decision-making skills
  • Maintain strong attention to detail and organization
  • Prioritize multiple competing tasks in a fast-paced environment
  • Use Microsoft Office and perform data entry proficiently
  • Hold a valid driver’s license, automobile insurance, and reliable transportation
  • Drive within the assigned territory and flex to other areas as needed
  • Pass a required background check

Benefits

  • Annual employee bonus program
  • Comprehensive wellness program
  • Generous paid time off
  • 11 paid holidays each year
  • One floating holiday
  • Birthday off
  • Two volunteer days
  • 401(k) retirement savings plan with employer matching
  • Employee recognition program
  • Tuition reimbursement
  • Equal pay and inclusive benefits
  • Opportunity to join a team serving members and the community

Related Jobs

BlueCross BlueShield of South Carolina

Auditor II, Medicare Cost Reporting

BlueCross BlueShield of South Carolina
ConsultingHealthcareLegal
USUnited StatesALAlabamaAKAlaskaAZArizonaCACaliforniaCOColoradoCTConnecticutFLFloridaHIHawaiiIDIdahoILIllinoisIAIowaKSKansasKYKentuckyLALouisianaMEMaineMDMarylandMAMassachusettsMIMichiganMNMinnesotaMSMississippiMOMissouriMTMontanaNENebraskaNVNevadaNHNew HampshireNJNew JerseyNMNew MexicoNYNew YorkNCNorth CarolinaNDNorth DakotaOHOhioOKOklahomaOROregonPAPennsylvaniaRIRhode IslandSCSouth CarolinaSDSouth DakotaTNTennesseeTXTexasUTUtahVTVermontVAVirginiaWAWashingtonWIWisconsinWYWyoming
$49,447 – $94,737 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Conducts financial, compliance, and operational audits for BlueCross Blue Shield of South Carolina, with a focus on Medicare cost reports. Evaluates controls and business risks, recommends corrective actions, and supports remote audits across the United States.

Open
CVS Health

Remote Medical Coding Quality Auditor at CVS Health

CVS Health
HealthcareHealthcare InsuranceRetail
USUnited StatesALAlabamaAZArizonaCACaliforniaCOColoradoCTConnecticutFLFloridaIDIdahoILIllinoisIAIowaKSKansasKYKentuckyLALouisianaMEMaineMDMarylandMAMassachusettsMIMichiganMNMinnesotaMSMississippiMOMissouriMTMontanaNENebraskaNVNevadaNHNew HampshireNJNew JerseyNMNew MexicoNYNew YorkNCNorth CarolinaNDNorth DakotaOHOhioOKOklahomaOROregonPAPennsylvaniaRIRhode IslandSCSouth CarolinaSDSouth DakotaTNTennesseeTXTexasUTUtahVTVermontVAVirginiaWAWashingtonWVWest VirginiaWIWisconsinWYWyoming
$18 – $38 / hour
RemoteFull-timeJuniorEnglish RequiredAuditor

Review medical records, validate ICD risk-adjustment diagnoses, and support compliance with CMS requirements at CVS Health. This U.S.-remote position calls for a coding certification and relevant medical-record auditing experience.

Open