Inpatient Hospital Auditor II

Job not on LinkedIn

🔥 3 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $79.1k - $105.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• 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