NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000
Inpatient Hospital Auditor II
October 29
NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000
Description
• Responsible for being the lead on site 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. • Provides guidance/instruction to various stakeholders on ICD9- CM, DRG assignment payment and auditing. • 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 and 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 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. • Demonstrates knowledge, understanding and conforms to laws, regulations and policies that pertain to the organizational units business.
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-9-CM training and education. • Additional licensing, certifications, registrations: RN license preferred, RHIT/RHIA certification, New Jersey Hospital Association membership. • Valid Driver's license and access to a car. • Preferred CCS, CCS-P or CCA certifications.
Benefits
• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement
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🇺🇸 United States – Remote
💵 $43.9k - $67.1k / year
🔥 Funding within the last year
💰 Private Equity Round on 2024-07
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔎 Auditor