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.

• Develop, analyze, and monitor trends related to institutional audits.

• Create audit protocols and engage in special projects.

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

• Offer guidance and training to stakeholders on ICD-9-CM, DRG assignment payment, and auditing processes.

• Detect and report billing discrepancies uncovered during audits.

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

• Recognize error patterns in medical records and billing documentation or provider contract terms.

• Gather statistics and audit information for accounts, regulatory bodies, and internal requests.

• Review and enhance audit procedures in collaboration with the manager.

• Train new employees on departmental and audit protocols.

• Fulfill other special assignments as directed by the manager.

• Ensure compliance with relevant laws, regulations, and organizational policies.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• A Bachelor's degree in Health Information Management is preferred, or relevant experience may be considered 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 ICD-9-CM training and education.

• RN license is preferred.

• RHIT or RHIA certification is required.

• Membership in the New Jersey Hospital Association.

• A valid driver's license and access to a vehicle.

• Preferred certifications include CCS, CCS-P, or CCA.

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

• Knowledge of utilization management principles.

• Familiarity with hospital structures and payment systems.

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

• Preferred knowledge of ACCESS Software.

• Strong verbal and written communication abilities.

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

• Demonstrated professionalism and ethical business practices, adhering to company standards.

• Effective time management, prioritization skills, and capability to deliver timely and accurate outputs.

• Ability to thrive in a production-oriented environment.

• Capability to ask insightful questions and gather comprehensive and pertinent information.

• Openness to cross-training and assisting in various roles and responsibilities.

• Detail-oriented with strong organizational and data processing abilities.

• Competence in following detailed instructions.

• Strong problem-solving, analytical, and research skills.

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

🏝️ Benefits

• Extensive health benefits including Medical, Dental, and Vision coverage.

• Retirement savings plans.

• Generous paid time off (PTO).

• Incentive programs.

• Wellness initiatives.

• Paid Volunteer Time Off.

• Tuition reimbursement opportunities.

• Meaningful work that positively impacts lives.

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