Overview In this role you conduct on-site and desk audits of hospital billing and coding, develop and track audit trends, and support DRG validation and per diem reviews. You guide stakeholders on ICD-9-CM, ICD-10, and auditing practices, ensuring accuracy and regulatory compliance. You will train new staff and collaborate across teams to improve processes and cost containment. The position emphasizes data-driven audits in a fast-paced, production-focused environment, with field execution across NJ, PA, and NY.
Responsibilities- Identify billing discrepancies found during audits and route improper payments through appropriate channels
- Detect error trends in medical records or billing documentation and provider contract interpretations
- Compile audit statistics for accounts, regulators, and internal requests
- Review and update audit processes to align with new clinical data review innovations and cost containment goals
- Train new staff on department and audit procedures
- Perform special assignments as requested by management
- Comply with laws, regulations, and policies relevant to the unit's business
- Travel 85-90% to facilities in NJ, PA, and NY
Key requirements- Bachelor's degree in Health Information Management or related field or RN with CCS certification
- Minimum 3 years of experience in a hospital medical records department or similar health care setting
- Experience with DRG validation and ICD-9-CM or ICD-10 training
- RHIA or RHIT certification; or RN with CCS certification
- Valid driver's license and access to a car
- Knowledge of medical terminology, anatomy & physiology, and hospital payment systems
- Proficiency in Microsoft Office (Excel, Word, PowerPoint) and preferably ACCESS Software
- Strong verbal/written communication and ability to work in a team
- Detail-oriented with strong organizational and data processing skills
- Ability to manage multiple priorities and deliver timely, accurate work
- strong communication
- teamwork
- training/mentoring
- ICD-9-CM/ICD-10 knowledge
- DRG validation
- ACCESS Software
