Lead On-Site Inpatient Billing & DRG Auditor

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); 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 a lead on-site auditor to oversee hospital billing and coding audits, develop audit protocols, and track institutional trends. You will finalize per diem, bill verification, DRG validation, and credit balance tasks while guiding stakeholders on ICD-10-CM, ICD-10-PCS & DRG assignments.

The role requires practical experience in medical records, DRG validation, and ICD-10-CM training, with RHIT/RHIA or RN with CCS preferred.

Qualifications

• Minimum of 3 years experience in a medical records department of an acute care hospital or health care facility.
• Experience with DRG validation, ICD-10-CM training and education.
• RHIT/RHIA certification OR RN with CCS preferred.

Responsibilities

• Lead on-site audits of hospital billing and coding practices and desk audits.
• Develop audit protocols, profiling and tracking institutional audit trends.
• Perform DRG validation, utilization review audits and credit balance work.
• Train new staff on department procedures and audit processes.
• Identify billing discrepancies and coordinate referrals for improper payments.
• Conform to laws, regulations, and company policies pertaining to the unit.
• Support cost containment initiatives through process improvements.

Skills

Verbal communication

Written communication

MS Office

Time management

Analytical skills

Problem solving

Education

Bachelor degree in Health Information Management

High School Diploma/GED

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a lead on-site auditor to oversee hospital billing and coding audits, develop audit protocols, and track institutional trends. You will finalize per diem, bill verification, DRG validation, and credit balance tasks while guiding stakeholders on ICD-10-CM, ICD-10-PCS & DRG assignments.

The role requires practical experience in medical records, DRG validation, and ICD-10-CM training, with RHIT/RHIA or RN with CCS preferred.