Find work in the United States.

A simpler way to find your next job.

Jobs in the United States

25+ jobs

Save this search

Added just now
H
Project Engineer II (Geotechnical)- Chantilly, VA
Hillis-Carnes
Chantilly, VA
- $80,000 to $120,000 USD / year
The successful candidate will provide technical leadership on geotechnical engineering and CMT projects, mentor junior staff, support field operations, and contribute to business…
Added 1 min ago
Deputy Program Manager
GD Information Technology, Inc.
United States
The Deputy Program Manager supports critical and diverse functions as the operational leader coordinating day‑to‑day Scientific Computing services that support Food and Drug Administration…
Added 3 mins ago
Senior Project Controls Manager - Aviation
STV Incorporated
San Francisco, CA
STV is seeking a Senior Project Controls Manager to join our growing Project Controls team in multiple client office locations across the United States. This leadership role will support…
Added 10 mins ago
Fleet Maintenance Manager - BU
BFI WASTE SERVICES, LLC
Chattanooga, TN
POSITION SUMMARY: The Business Unit Fleet Maintenance Manager is responsible for overseeing up to 5+ maintenance shops and managing multiple teams of technicians, maintenance supervisors…
Added 10 mins ago
Operations Supervisor Hauling
BFI WASTE SERVICES, LLC
Adairsville, GA
…oversees drivers and helpers and works with the Operations Manager and General Manager to implement tactical initiatives to drive functional excellence and budget achievement. The…
Added 10 mins ago
Diesel Mechanic
BFI WASTE SERVICES OF PENNSYLVANIA, LLC
King Of Prussia, PA
POSITION SUMMARY: With direct supervision from a Lead Technician, Maintenance Supervisor or Maintenance Manager, a Maintenance Technician B performs repair and maintenance work on diesel…
Added 12 mins ago
AI Principal Technical Program Manager
JPMC page
New York, NY · NY
As a Principal Technical Program Manager at JPMorganChase in Corporate- AI/ML Data Platforms team, you will lead complex, multi-functional technology projects and programs that will impact…
Added 17 mins ago
Engineer Manager
ASTEMO AMERICAS, INC.
Farmington Hills, MI
Lead research and development, quality control and product modification and improvement activities in alignment with established program objectives.
Added 26 mins ago
BS
Infrastructure and Operations Principal Architect, ITD
Brookhaven Science Associates, LLC
Upton, NY
- $126,000 to $222,500 USD / year
Brookhaven National Laboratory is seeking a multidisciplinary technical leader to serve as the Infrastructure and Operations (I&O) Principal Architect within the Information Technology…
Added 35 mins ago
IME Washington Operations Manager
Dane Street, LLC
Remote, United States
The Washington Operations Manager oversees daily center operations to drive overall profitability, team efficiency, and sustained referral growth. By setting performance expectations and…
Added 35 mins ago
IME Washington Operations Manager
Dane Street, LLC
Remote, United States
The Washington Operations Manager oversees daily center operations to drive overall profitability, team efficiency, and sustained referral growth. By setting performance expectations and…
Added 35 mins ago
IME Washington Operations Manager
Dane Street, LLC
Remote, United States
The Washington Operations Manager oversees daily center operations to drive overall profitability, team efficiency, and sustained referral growth. By setting performance expectations and…
Added 41 mins ago
Health Industry - Patient Access & Experience Manager
Accenture LLP Company
NY
As a Patient Access & Experience Manager in our Health Provider business, you lead and support patient access and experience transformations for complex provider organizations such as…
Added 58 mins ago
Senior District Manager, Oncology, Lung Head & Neck
J&J Family of Companies
Horsham, PA
Johnson & Johnson Innovative Medicine is recruiting for a Senior District Manager, Oncology, Lung Head & Neck cancers to be based in the Upstate NY-MA District which includes: Boston, MA,…
Added 58 mins ago
Senior District Manager, Oncology, Lung Head & Neck
J&J Family of Companies
Horsham, PA
Johnson & Johnson Innovative Medicine is recruiting for a Senior District Manager, Oncology, Lung Head & Neck cancers to be based in the New York City District which includes: NYC, Long…
Added 1 hour ago
Operations Supervisor Hauling
WASTE SERVICES, LLC
Calhoun, GA
…oversees drivers and helpers and works with the Operations Manager and General Manager to implement tactical initiatives to drive functional excellence and budget achievement. The…
Added 1 hour ago
Fleet Maintenance Manager - BU
WASTE SERVICES, LLC
Chattanooga, TN
POSITION SUMMARY: The Business Unit Fleet Maintenance Manager is responsible for overseeing up to 5+ maintenance shops and managing multiple teams of technicians, maintenance supervisors…
Added 1 hour ago
2027-28 High School Teacher (Pool)
KIPP
Jacksonville, FL
Respect - For our teachers’ innate talent and desire to learn, for their professional growth, and for the lives they lead beyond our walls. We offer pay and benefits that reflect our…
Added 1 hour ago
Professional Services, Program Manager
Jobgether
Remote, United States
As a Professional Services, Program Manager, you will lead complex, multi-workstream service engagements, helping strategic customers turn transformation objectives into successful delivery…
Added 1 hour ago
Senior Product Manager, Data Platform
Curinos Inc
New York, NY
We are seeking a Senior Product Manager to lead the Data Platform pod and own the vision, roadmap and outcomes for the full Curinos Lakehouse on Databricks. The scope runs from ingestion…
Added 1 hour ago
Maintenance Supervisor
CYM Living LLC
Bridgeton, MO
…empower growth from within. As a vertically integrated firm, we lead operations by taking a hands-on approach to real estate investment and property management. We accomplish our mission by…
Added 2 hours ago
Lead Product Manager (SaaS & AI Agent)
CWILL
Remote, United States
Define the Lighthouse Customer program and expansion ARR playbook
Added 2 hours ago
Lead Product Manager (SaaS & AI Agent)
CWILL
Remote, United States
Define the Lighthouse Customer program and expansion ARR playbook
Added 2 hours ago
Lead Product Manager (SaaS & AI Agent)
CWILL
Remote, United States
Define the Lighthouse Customer program and expansion ARR playbook
Added 2 hours ago
Lead Product Manager (SaaS & AI Agent)
CWILL
Remote, United States
Define the Lighthouse Customer program and expansion ARR playbook

Default - MMO

Clinical Auditor

Cleveland, OH, United States

Apply About employer

Applications open in a new tab.

Job details

Posting language: English
Posted: Nov 4, 2026

Original job description

Medical Mutual employees must submit their applications through MySource.

Note: This is a remote role. Seeking applicants that reside within 50 miles of the Brooklyn, Ohio office. Certified Medical Coder (CPC, CCS, or equivalent) credential preferred.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Working under general supervision, audits complex outpatient, inpatient and professional claim irregularities, overpayments and provider appeals from a clinical coding perspective, applying coding guidelines. Analyzes provider billing for abnormalities, questionable billing practices and proper coding combinations from a clinical and coding perspective and documents denial reasoning or erroneous activity.

Responsibilities:

Clinical Auditor

Audits outpatient, inpatient and professional claims from a clinical and coding perspective applying coding guidelines and edits. Assesses for inappropriate billing combinations, inherent charges, provider supporting documentation, etc.
Documents audit results including denial reasons, erroneous activities, etc. and updates systems accordingly.
Maintains knowledge in coding and billing guidelines and trends.
Reviews provider appeals applying coding guidelines or edits.
Identifies edits to adjudication system that are not working properly or need to be installed so claims can be processed. Works with more senior levels to implement changes.
Interacts with internal or external auditors or vendors on claim coding updates, procedure changes, etc.
Discusses consult findings with Physician Reviewers and reviews edit updates and questions with payment recovery staff.
Performs other duties as assigned

Senior Clinical Auditor

Audits outpatient, inpatient and professional claims from a clinical and coding perspective applying coding guidelines and edits. Assesses for inappropriate billing combinations, inherent charges, provider supporting documentation, etc
Documents audit results including denial reasons, erroneous activities, etc. and updates systems accordingly.
Identifies additional opportunities for recovery and avoidance. Researches opportunities to better control medical spending and presents ideas to management.
Researches and maintains knowledge in coding and billing guidelines and trends. Participates in implementation of new or updated policies and processes.
Reviews provider appeals applying coding guidelines or edits.
Identifies edits to adjudication system that are not working properly or need to be installed so claims can be processed. Works with lead or manager to implement changes.
Orients, trains, assists and reviews work of more junior level staff.
Interacts with internal or external auditors or vendors on claim coding updates, procedure changes, etc.
Discusses consult findings with Physician Reviewers and reviews edit updates and questions with payment recovery staff.
Performs other duties as assigned.

Qualifications:

Clinical Auditor

Education and Experience:

Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s Degree preferred.
In lieu of RN, Bachelor of Science in medical related field.
3 years as a Clinical Auditor or equivalent combination of clinical and medical auditing experience.

Professional Certification(s):

Certified Medical Auditor (if not certified required to obtain within 24 months of hire).
Certified Coder preferred.

Technical Skills and Knowledge:

Knowledge of ICD codes.
Knowledge of procedure codes.
Knowledge of Revenue Codes, HCPC Codes and CPT codes
Knowledge of industry standard billing rules and regulations for professional claims billing, outpatient claims billing and inpatient claims billing.
Knowledge of insurance regulations.
Knowledge of coding and auditing techniques.
Good written communication skills.
Intermediate Microsoft Office and claims adjudications systems skills

Senior Clinical Auditor

Education and Experience:

Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s Degree preferred.
In lieu of RN, Bachelor of Science in medical related field.
5 years as a Clinical Auditor or equivalent combination of clinical and medical auditing experience.

Professional Certification(s):

Certified Coder or Certified Medical Auditor (if not certified required to obtain within 24 months of hire).

Technical Skills and Knowledge:

Strong knowledge of ICD codes.
Strong knowledge of procedure codes.
Strong knowledge of Revenue Codes, HCPC Codes and CPT codes.
Strong knowledge of industry standard billing rules and regulations for professional claims billing, outpatient claims billing and inpatient claims billing.
Strong knowledge of insurance regulations.
Strong knowledge of coding and auditing technique.
Strong written communication skills.
Intermediate to advanced Microsoft Office and claims adjudications systems skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.

Excellent Benefits and Compensation:

Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Apply About employer

Report this job