On-Site Inpatient Audit Lead - DRG/ICD-10

Financeroles; Hopewell (VA); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

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 for hospital billing and coding practices. The role covers desk audits, DRG validation, and overseeing audit projects while guiding stakeholders on ICD-10-CM/PCS and DRG assignments.

The position requires a health information background, RHIT/RHIA or RN/CCS credentials, and experience in medical records auditing. Strong communication and analytical skills are essential.

Qualifications

• High School Diploma or 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 health care facility.
• Experience with DRG validation, ICD-10-CM training and education.

Responsibilities

• Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels.
• Identifies error trends related to medical record/billing documentation or misinterpretation of provider contracts.
• Compiles statistics and audit information to present to accounts, regulatory agencies, internal requesters.
• Reviews and updates audit processes to align with new innovations in clinical data review and cost containment initiatives.
• Train new staff on department/audit procedures.
• Perform other special assignments as requested by manager.
• Demonstrates knowledge of laws, regulations and policies relevant to the organization.

Skills

Effective communication

MS Office proficiency

Time management

Detail oriented

Analytical/problem solving

Team collaboration

Education

High School Diploma/GED

Bachelor degree in Health Information Management

Tools

ACCESS Software

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a lead on-site auditor for hospital billing and coding practices. The role covers desk audits, DRG validation, and overseeing audit projects while guiding stakeholders on ICD-10-CM/PCS and DRG assignments.

The position requires a health information background, RHIT/RHIA or RN/CCS credentials, and experience in medical records auditing. Strong communication and analytical skills are essential.