Senior Auditor Appeals - OPSP

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Auditor Appeals - OPSP in the United States.

In this specialized clinical auditing role, you will be responsible for reviewing complex healthcare claim determinations and appeals, ensuring accuracy, compliance, and alignment with clinical coding and reimbursement guidelines. You will analyze medical records, prior audit decisions, and provider-submitted documentation to validate or overturn recovery determinations. This role requires deep expertise in clinical validation and coding standards, as well as the ability to communicate clear, well-supported decisions in writing. Acting as a subject matter expert, you will also contribute to improving audit quality by providing feedback to internal teams. The environment is highly detail-driven, regulated, and quality-focused, requiring strong analytical thinking and professional judgment. Your work will directly impact the accuracy and integrity of healthcare payment decisions across complex claim types.

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Auditor Appeals - OPSP in the United States.

In this specialized clinical auditing role, you will be responsible for reviewing complex healthcare claim determinations and appeals, ensuring accuracy, compliance, and alignment with clinical coding and reimbursement guidelines. You will analyze medical records, prior audit decisions, and provider-submitted documentation to validate or overturn recovery determinations. This role requires deep expertise in clinical validation and coding standards, as well as the ability to communicate clear, well-supported decisions in writing. Acting as a subject matter expert, you will also contribute to improving audit quality by providing feedback to internal teams. The environment is highly detail-driven, regulated, and quality-focused, requiring strong analytical thinking and professional judgment. Your work will directly impact the accuracy and integrity of healthcare payment decisions across complex claim types.

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

 Why Apply Through Jobgether? 

 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

 

 

#LI-CL1