Lead Hospital Billing & Coding Auditor

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (AL); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an on-site Audit Lead for hospital billing and coding practices, including DRG validation and per diem reviews.

You will design audit protocols, train staff, identify discrepancies, monitor trends, and report findings to leadership while ensuring compliance with regulatory requirements and company policies.

Join a mission-driven team dedicated to quality care, affordability and member experience.

Qualifications

• HS Diploma/GED required.
• Bachelor degree in Health Information Management preferred or relevant experience.
• Minimum 3 years experience in a medical records department of an acute care hospital or health care facility.
• Experience with DRG validation and ICD-10-CM training.

Responsibilities

• Lead on-site audits of hospital billing and coding practices and desk audits; develop forms and track trends.
• Design audit protocols and special projects; train new staff on procedures.
• Identify billing discrepancies and coordinate referral of improper payments.
• Present statistics and audit information to internal stakeholders and regulators.

Skills

Communication skills

MS Office (Excel, Word, PowerPoint)

Time management

Attention to detail

Analytical skills

Team collaboration

Education

HS Diploma/GED

Bachelor's in Health Information Management preferred

Tools

ACCESS Software

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an on-site Audit Lead for hospital billing and coding practices, including DRG validation and per diem reviews.

You will design audit protocols, train staff, identify discrepancies, monitor trends, and report findings to leadership while ensuring compliance with regulatory requirements and company policies.

Join a mission-driven team dedicated to quality care, affordability and member experience.