Inpatient Hospital Auditor II

Job Description: • Responsible for being the lead audits of hospital billing and coding practices and desk audits • Forms development, profiling and tracking institutional audit trends • Designing audit protocols and special projects • Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance • Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels • Identifies error trends as they relate to medical record and or billing documentation or misinterpretation of provider contract stipulations • Compiles statistics and other audit information to present to accounts, regulatory agencies, internal requesters • Reviews and updates audit processes with manager for purposes of keeping up with new innovations in clinical data review and company cost containment initiatives • Required to train new staff on department/audit procedures • Performs other special assignments as requested by manager. Requirements: • High School Diploma/GED required • Bachelor degree in Health Information Management preferred or relevant experience in lieu of degree • Requires a 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/PCS training and education • Requires RHIT, RHIA or RN with CCS • Preferred CCS, CCS-P or CCA certifications for those with RHIT or RHIA credentials • Requires knowledge of medical terminology, detailed knowledge of anatomy & physiology • Requires knowledge of principles of utilization management • Requires knowledge of hospital structures and payment systems • Requires knowledge of centers of Medicare and Medicaid prospective payment system regulations • Prefer knowledge of ACCESS Software. Benefits: • Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement Apply tot his job Apply To this Job