Inpatient Hospital Auditor II

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Oversee on-site audits of hospital billing and coding practices as well as desk audits.

• Create, analyze, and monitor institutional audit trends.

• Develop audit protocols and manage special projects.

• Conduct and conclude per diem, bill verification, DRG validation/utilization review audits, and credit balance audits.

• Offer guidance and instruction to stakeholders regarding ICD-10-CM, ICD-10-PCS, DRG assignment, payment, and auditing processes.

• Detect and report billing discrepancies identified during audits.

• Facilitate the referral of improper claim payments through the appropriate channels.

• Recognize error trends related to medical records, billing documentation, and provider contract requirements.

• Assemble statistics and audit information for accounts, regulatory agencies, and internal requests.

• Review and enhance audit procedures with management to align with advancements in clinical data review and cost-containment strategies.

• Train new employees on departmental and audit procedures.

• Execute additional special assignments as requested by the manager.

• Adhere to laws, regulations, and policies relevant to organizational business units.

⛳️ Requirements

• High School Diploma/GED is required.

• Bachelor's degree in Health Information Management is preferred, or relevant experience may be accepted in lieu of a degree.

• At least 3 years of experience in a medical records department within an acute care hospital or other healthcare facility.

• Familiarity with DRG validation, and experience in ICD-10-CM training and education.

• RHIT/RHIA certification or RN with CCS is required.

• Understanding of medical terminology, anatomy, physiology, disease pathogenesis and treatment, procedural drug therapies, as well as ancillary and diagnostic services.

• Knowledge of utilization management principles.

• Familiarity with hospital structures and payment systems.

• Understanding of Centers for Medicare and Medicaid prospective payment system regulations.

• Preference for knowledge of ACCESS Software.

• Excellent verbal and written communication skills.

• Proficient PC skills and experience with Microsoft Office applications: Excel, Word, and PowerPoint.

• Commitment to professional and ethical business practices and adherence to company standards.

• Strong time management skills, with the ability to handle multiple priorities and deliver timely, accurate work products.

• Capable of working in a production-focused environment.

• Ability to ask insightful questions and gather comprehensive and relevant information.

• Willingness to cross-train and learn other roles/duties.

• Detail-oriented with robust organizational and data processing skills.

• Competent in following detailed instructions.

• Possess problem-solving, analytical, and research abilities.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement plans.

• Generous paid time off (PTO).

• Incentive plans.

• Wellness programs.

• Paid volunteer time off.

• Tuition reimbursement.

• Meaningful work that directly enhances lives.

• Mission-driven organization that values expertise, collaboration, and growth.