Inpatient Hospital Auditor II
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Inpatient hospital auditor reviewing billing, coding, DRG validation, and improper payments for Horizon BCBSNJ. Developing audit protocols and tracking hospital audit trends.
Responsibilities:
- Lead on-site audits of hospital billing and coding practices and desk audits
- Develop, profile, and track institutional audit trends
- Design audit protocols and special projects
- Perform and finalize per diem, bill verification, DRG Validation/utilization review audits, and credit balance audits
- Provide guidance and instruction to stakeholders on ICD-10-CM, ICD-10-PCS, DRG assignment, payment, and auditing
- Identify and present billing discrepancies found during audits
- Coordinate referral of improper claim payments through appropriate channels
- Identify error trends related to medical records, billing documentation, and provider contract stipulations
- Compile statistics and audit information for accounts, regulatory agencies, and internal requesters
- Review and update audit processes with the manager to keep pace with clinical data review innovations and cost-containment initiatives
- Train new staff on department and audit procedures
- Perform other special assignments requested by the manager
- Comply with laws, regulations, and policies applicable to organizational business units
Requirements:
- High School Diploma/GED required
- Bachelor degree in Health Information Management preferred or relevant experience in lieu of degree
- Minimum of 3 years experience in a medical records department of an acute care hospital or other health care facility
- Experience with DRG validation, ICD-10-CM training and education
- RHIT/RHIA certification OR RN with CCS
- Knowledge of medical terminology, anatomy and physiology, disease pathogenesis and treatment, procedural drug therapies, ancillary and diagnostic services
- Knowledge of principles of utilization management
- Knowledge of hospital structures and payment systems
- Knowledge of Centers for Medicare and Medicaid prospective payment system regulations
- Prefer knowledge of ACCESS Software
- Effective verbal and written communication skills
- Strong PC skills and experience with Microsoft Office programs: Excel, Word and PowerPoint
- Professional and ethical business practices and adherence to company standards
- Time management, ability to manage multiple priorities, and ability to deliver timely and accurate work products
- Ability to work in a production-focused environment
- Ability to ask probing questions and obtain thorough and relevant information
- Willingness to cross-train and be cross-trained in other roles/duties
- Detail-oriented with strong organizational and data processing skills
- Ability to follow detailed instructions
- Problem-solving, analytical, and research skills
- Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
- Meaningful work that directly improves lives
- Mission-driven organization that values expertise, collaboration, and growth
Similar Jobs
Internal Auditor
Internal Auditor evaluating controls, compliance, and risks at Apple Federal Credit Union. Conducting data-driven audits and reporting findings across credit union operations.
Senior Claims Auditor
Senior Claims Auditor reviewing complex crop insurance claims for AgriSompo North America. Auditing files, resolving issues, and supporting agents, producers, and underwriting teams.
Senior Lease Auditor
Senior Lease Auditor reviewing commercial real estate expenses and lease compliance for Colliers. Analyzing landlord charges, resolving disputes, and reporting audit findings across multiple U.S. locations.
Coding Auditor
Remote Coding Auditor auditing inpatient and outpatient coding for Med-Metrix. Preparing compliance reports, educating physicians, and ensuring HIPAA-compliant documentation.
Stop Loss Claims Auditor
Specific Stop Loss Claims Auditor auditing healthcare claims for Brown & Brown’s risk-management clients. Applying stop-loss policy rules, deductibles, coinsurance, and repricing methodologies.
Auditor
US Auditor conducting financial statement audits for Asiacruit’s US-based clients. Testing controls, identifying risks, and preparing accurate audit documentation.
Quality Auditor
Quality Auditor ensuring ResMed medical-device compliance through supplier and internal audits. Managing CAPA findings, regulatory responses, and Quality Systems improvements.
Senior Premium Auditor
Senior Premium Auditor conducting insurance audits, classifying risk exposures, and determining earned premiums. Working remotely from California while covering policyholders across all U.S. states.
Vehicle Inventory Representative, Auditor
Part-time field representative auditing repair facilities and inventorying dealership vehicles for CCC’s insurance technology platform. Flexible scheduling with 75% or more travel.
Part-Time Financial Compliance Auditor – AML/CFT
Part-time financial compliance auditor examining Honduran regulated entities’ AML/CFT controls. Testing KYC, transaction monitoring, sanctions screening, evidence, findings, and remediation.
AI Task Auditor, Freelance AI Trainer
SWE-Bench AI task auditor reviewing software-engineering tasks for Meridial’s AI training and evaluation systems. Providing technical audits, reproducibility checks, and actionable codebase feedback.
Kubernetes AI Task Auditor, Freelance AI Trainer
Kubernetes AI task auditor evaluating technical training tasks for AI systems. Providing actionable feedback on orchestration, configuration, testing, and logic accuracy.
Risk Adjustment, HCC Coder, Auditor
HCC Auditor validating risk-adjustment codes and medical records for e4health healthcare clients. Reporting audit results and training coders and providers remotely.
Facility Coding Auditor
ASC coding auditor reviewing medical records and coding data for healthcare facilities. Identifying compliance risks, reducing denials, and improving reimbursement accuracy.
LPN – Notice Of Action Letter Auditor
LPN auditing notice-of-action letters for CVS Health’s healthcare services operations. Applying clinical guidelines to ensure timely, accurate member and provider communications.
Stop Loss Claim Auditor Intern
Stop-loss claim auditing intern supporting CTI Audit Solutions' healthcare claims audits. Reviewing documentation, analyzing medical data, and preparing audit findings remotely.
Internal Process Auditor
Internal Process Auditor ensuring ISO 9001:2015 compliance across KAIZEN’s PPM, AMC, and building insurance services. Leading audits, risk management, QMS improvements, and corrective actions.
Claims Auditor
Claims Auditor reviewing managed-care claims and reporting processing errors for Providence healthcare network. Ensuring data integrity, adjudication accuracy, and regulatory compliance.
Senior Inpatient Coding Auditor
Inpatient coding auditor reviewing medical records, diagnoses, procedures, and DRG assignments. Supporting Gainwell’s healthcare solutions through compliant audits, documentation, and coder training.
Associate REMS Auditor
Associate REMS Auditor supporting stakeholder audits, documentation review, and FDA/REMS compliance. UBC provides pharmaceutical support services across drug development and commercialization.