Inpatient Billing & DRG Audit Lead

100 Horizon Healthcare Services, Inc; Hopewell (NJ); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Dental/Vision

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a lead on-site auditor for hospital billing and coding practices, performing per diem and DRG validation audits. You will design audit protocols, develop forms, and track trends while guiding stakeholders on ICD-10-CM, ICD-10-PCS, and DRG assignments for payment and auditing.

The role requires 3+ years in medical records auditing in acute care settings, RHIT/RHIA or CCS credentials, and strong knowledge of utilization management and CMS payment

Qualifications

• 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 required.
• Knowledge of utilization management principles.
• Knowledge of hospital structures and payment systems.
• Knowledge of CMS prospective payment system regulations.
• ACCESS Software knowledge preferred.

Responsibilities

• Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments.
• Identifies error trends related to medical record or billing documentation or contract stipulations.
• Compiles statistics and audit information for accounts, regulators, and internal requests.
• Reviews and updates audit processes to align with new innovations and cost containment.
• Trains new staff on department/audit procedures.
• Performs other special assignments as requested by manager.
• Adheres to laws, regulations, and policies relevant to the business unit.

Skills

Communication

Technical explanations

MS Office

Team player

Time management

Multitasking

Detail oriented

Problem solving

Cross-training

Education

Bachelor's in Health Information Management

RHIT/RHIA or CCS certification

High School Diploma/GED

Tools

ACCESS Software

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a lead on-site auditor for hospital billing and coding practices, performing per diem and DRG validation audits. You will design audit protocols, develop forms, and track trends while guiding stakeholders on ICD-10-CM, ICD-10-PCS, and DRG assignments for payment and auditing.

The role requires 3+ years in medical records auditing in acute care settings, RHIT/RHIA or CCS credentials, and strong knowledge of utilization management and CMS payment