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H
Inpatient Hospital Auditor II
Horizon Connect @ Wall BCBSNJ. Lead on-site audits of hospital billing and coding practices and desk audits .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in hospital billing and coding audits, including DRG validation and ICD-9-CM training. Proficient in compliance with healthcare regulations and effective communication with stakeholders.
Highest-signal resume keywords
DRG ValidationICD-9-CM TrainingRHIT/RHIA CertificationMedical Terminology KnowledgeUtilization Management Principles
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Audit Protocol DesignBilling Discrepancy IdentificationStatistical CompilationCredit Balance AuditsPer Diem AuditsBill Verification AuditsUtilization Review AuditsData Processing SkillsDetail-Oriented AnalysisProblem-Solving Skills
Soft Skills
Effective Communication SkillsTime ManagementOrganizational SkillsAbility to Follow InstructionsAnalytical Skills
Tools & Technologies
ACCESS SoftwareMicrosoft ExcelMicrosoft WordMicrosoft PowerPoint
Certifications & Qualifications
RHIT CertificationRHIA CertificationCCS CertificationCCS-P CertificationCCA Certification
Industry Keywords
Hospital BillingCoding PracticesHealthcare ComplianceCenters for Medicare and Medicaid RegulationsMedical Records Management
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-9-CM, 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 involving medical record and billing documentation or provider contract stipulations
- Compile statistics and audit information for accounts, regulatory agencies, and internal requesters
- Review and update audit processes with the manager
- Train new staff on department and audit procedures
- Perform other special assignments as requested by the manager
- Demonstrate compliance with applicable laws, regulations, and policies
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-9-CM training and education
- RN license preferred
- RHIT/RHIA certification
- New Jersey Hospital Association membership
- Valid Driver's license and access to a car
- Preferred CCS, CCS-P or CCA certifications
- 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
- Preferred 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, prioritization, 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