Inpatient Hospital Auditor II

Horizon Connect @ Wall BCBSNJ

. Lead on-site audits of hospital billing and coding practices and desk audits .

Posted 9/18/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $79,100 - $105,945 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in hospital billing and coding audits, including DRG Validation and ICD-10-CM compliance. Proficient in training staff, analyzing audit trends, and ensuring adherence to regulatory standards.

Highest-signal resume keywords

DRG ValidationICD-10-CM TrainingRHIT/RHIA Certification OR RN With CCSUtilization Management PrinciplesMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Hospital Billing AuditsCoding PracticesAudit Protocol DesignCredit Balance AuditsMedical Terminology KnowledgeAnatomy and Physiology KnowledgeData Processing SkillsStatistical CompilationRegulatory ComplianceError Trend Identification

Soft Skills

Effective Communication SkillsTime ManagementDetail-OrientedProblem-Solving SkillsOrganizational Skills

Tools & Technologies

ACCESS SoftwareMicrosoft ExcelMicrosoft WordMicrosoft PowerPoint

Certifications & Qualifications

RHITRHIACCS

Industry Keywords

Acute Care HospitalCenters for Medicare and MedicaidPayment SystemsBilling DocumentationClinical Data Review

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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