RN Inpatient Hospital Auditor | Remote

RN Inpatient Hospital Auditor – Remote (New Jersey) – 6‑month contract, 3+ years experience –

Start date:

ASAP – Worker type: W2.

• Must be local to NJ, NY, DE, CT, PA
• 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 training and education.
• Requires RN license (can be compact) with CCS ORRHIT/RHIA certification.
• Requires knowledge of medical terminology, detailed knowledge of anatomy & physiology, disease pathogenesis and treatment including procedural drug therapies, ancillary and diagnostic services.
• Requires knowledge of principles of utilization management.
• Requires knowledge of hospital structures and payment systems.
• Requires knowledge of Centers of Medicare & Medicaid Prospective Payment System regulations.
• Preferred knowledge of ACCESS Software.

• This position is 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.
• Additionally provides guidance/instruction to various stakeholders on ICD‑10‑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 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.
• Demonstrates knowledge, understanding and conforms to laws, regulations and policies that pertain to the organizational unit’s business.

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.