Inpatient Hospital Auditor II

Horizon Healthcare Services•Hopewell, NJ

13d

About The Position

This position leads on-site audits of hospital billing and coding practices and desk audits. The role develops forms, profiles and tracks institutional audit trends, designs audit protocols and special projects, and performs and finalizes per diem, bill verification, DRG validation (utilization review) and credit balance audits. It also provides guidance and instruction to stakeholders on ICD-9-CM, DRG assignment, payment and auditing. The auditor identifies billing discrepancies and error trends, coordinates referrals of improper claim payments through appropriate channels, and compiles audit statistics and information for accounts, regulatory agencies and internal requesters. The position reviews audit processes with a manager to keep pace with clinical data review innovations and company cost-containment initiatives, trains new staff on department and audit procedures, and completes other special assignments as requested. The employee must understand and comply with applicable laws, regulations and policies.

Requirements

High school diploma or GED required.
At least 3 years of experience in a medical records department of an acute care hospital or other health care facility.
Experience with DRG validation and ICD-9-CM training and education.
Valid driver’s license and access to a car.
Knowledge of medical terminology; anatomy and physiology; disease pathogenesis and treatment, including procedural drug therapies, ancillary and diagnostic services; utilization management principles; hospital structures and payment systems; and Medicare and Medicaid prospective payment system regulations.
Effective verbal and written communication skills and ability to work well within a team.
Ability to explain highly technical information to less technical individuals.
Strong PC skills and experience with Microsoft Office programs, including Excel, Word and PowerPoint.
Professional and ethical business practices, adherence to company standards, and commitment to personal and professional development.
Time management skills and ability to manage multiple priorities, deliver timely and accurate work with a customer-service focus, and respond with urgency as required.
Ability to work in a production-focused environment, ask probing questions and obtain thorough and relevant information.
Willingness to cross-train and be cross-trained in other roles and duties.
Detail orientation and strong organizational and data-processing skills.
Ability to follow detailed instructions, with proven problem-solving, analytical and research skills.

Nice To Haves

Bachelor’s degree in Health Information Management, or relevant experience in lieu of a degree.
RN license.
RHIT or RHIA certification.
New Jersey Hospital Association membership.
CCS, CCS-P or CCA certification.
Knowledge of ACCESS Software.

Responsibilities

Lead on-site audits of hospital billing and coding practices and conduct desk audits.
Develop forms and profile and track institutional audit trends.
Design audit protocols and special projects.
Perform and finalize per diem, bill verification, DRG validation (utilization review) and credit balance audits.
Provide stakeholders with guidance and instruction on ICD-9-CM, DRG assignment, payment and auditing.
Identify and present billing discrepancies found during audits, and coordinate referrals of improper claim payments through appropriate channels.
Identify error trends related to medical records, billing documentation or interpretation of provider contract stipulations.
Compile statistics and other audit information for accounts, regulatory agencies and internal requesters.
Review and update audit processes with the manager to keep pace with clinical data review innovations and company cost-containment initiatives.
Train new staff on department and audit procedures.
Perform other special assignments as requested by the manager.
Demonstrate knowledge of and conform to applicable laws, regulations and policies.