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 bolthires 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