Clinical Operations Auditor

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Clinical Operations Auditor, you will conduct clinical operations audits, including quality medical chart reviews, under the supervision of the department Manager or Director. In this role, you will plan and perform audit tests and procedures to evaluate the adequacy and effectiveness of internal controls in ensuring compliance with organizational policies and procedures, Medicare regulations, The Joint Commission standards, and other applicable requirements. You will assist with auditing and monitoring compliance with medical necessity and regulatory requirements, reviewing clinical documentation and revenue cycle processes to identify opportunities to improve workflows, strengthen compliance, and support patient safety and quality.

This role offers a unique opportunity for nurses and candidates with healthcare auditing experience to transition from direct patient care into an administrative position while continuing to make an impact on patient care. You will combine your clinical knowledge with analytical and investigative work, reviewing clinical information, working with data in Excel, and documenting audit findings. The team also incorporates progressive technologies, including AI and Copilot tools, to support audit activities and report writing. This position requires onsite auditing at Cleveland Clinic locations and the ability to work with clinical teams and other stakeholders throughout the audit process.

A caregiver in this role works a hybrid schedule from 8:00 a.m. - 5:00 p.m., with two days per week onsite at the West Creek location in Independence.

Candidates must also be available to travel to Cleveland Clinic locations to conduct audits. Travel may include visits to Main Campus, Fairview, Mentor, and Hillcrest or other locations as needed.

A caregiver who excels in this role will:

• Conduct clinical operations audit assignments, including quality medical chart reviews, under the supervision of the department Manager or Director.
• Plan and perform audit tests and procedures to evaluate the adequacy and effectiveness of internal controls related to compliance with organizational policies and procedures, external laws and regulations, achievement of Cleveland Clinic goals and objectives, reliability of operational reports, efficient use of resources, and the deterrence and detection of fraud.
• Collect and analyze data from diverse sources using appropriate computer-assisted auditing techniques.
• Perform gap analyses of revenue cycle processes and recommend improvements.
• Assist with auditing and monitoring compliance with medical necessity and regulatory requirements.
• Conduct audits of clinical documentation and billing processes to evaluate accuracy and compliance.
• Collaborate with clinical teams to identify and mitigate clinical issues.
• Work closely with revenue cycle teams on billing and documentation audits.
• Support internal controls that promote patient safety and quality.
• Perform onsite visits to regional hospitals and Main Campus, with travel required and occasional flexibility outside standard onsite days.
• Develop and document audit findings, including recommendations to improve controls and reduce or recover costs.
• Document audit findings using established protocols; training will be provided.
• Participate in audit conferences and prepare written reports that effectively communicate audit findings and recommendations.
• Perform special projects and assignments as requested by departmental management.
• Comply with the Institute of Internal Auditors (IIA) Standards for the Professional Practice of Internal Auditing and Code of Ethics.
• Perform other duties as assigned.

Minimum qualifications for the ideal future caregiver include:

• Associate degree in related field or Nursing degree or Nursing School graduate and four years of functionally relevant work in a hospital setting
• OR High School diploma/GED and four years of functionally relevant work in a hospital setting with an additional two years of relevant experience
• Must have one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Professional Coder (CPC), Certified Medical Audit Specialist (CMAS), Certified Professional Coder Hospital (CPCH), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)
• Comprehensive knowledge of accounting/clinical operations/information technology principles and practices, auditing standards, analytical techniques, and internal controls

Preferred qualifications for the ideal future caregiver include:

• Bachelor's degree
• Registered Nurse (RN) or LPN with clinical experience
• Nurse with Coding experience
• Healthcare auditing experience
• Experience in clinical operations, revenue cycle, or compliance auditing
• Flexibility with work location and onsite auditing
• Excel/Microsoft experience

Physical Requirements:

• Requires traveling to various locations on campus as well as travel to off-campus sites.
• Requires dexterity sufficient to operate office equipment.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

Pay Range

Minimum Annual Salary: $57,510.00

Maximum Annual Salary: $87,697.50

The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic's benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities