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Horizon Connect @ Wall BCBSNJ
HealthcareHealthcare Insurance
Horizon Connect @ Wall BCBSNJ appears to represent a local program or office associated with Horizon Blue Cross Blue Shield of New Jersey. Its connection is to the healthcare insurance sector, with an apparent focus on local outreach and engagement involving members and healthcare providers in the Wall, New Jersey area. Available public information is limited, so the profile reflects the affiliation indicated by the organization’s name rather than a broader standalone company description.
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Inpatient Hospital Auditor II - Remote

Review hospital billing, coding, DRG validation, utilization, and improper payment activity for Horizon Connect @ Wall BCBSNJ. Develop audit protocols, identify payment discrepancies, and monitor institutional audit trends.

USUnited StatesCTConnecticutNJNew JerseyNYNew YorkPAPennsylvania
$79,100 – $105,945 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Description

  • Lead on-site and desk audits of hospital billing and coding practices
  • Develop, profile, and monitor institutional audit trends
  • Create audit protocols and manage special audit projects
  • Complete and finalize per diem, bill verification, DRG validation and utilization review, and credit balance audits
  • Advise stakeholders on ICD-10-CM, ICD-10-PCS, DRG assignment, payment, and auditing practices
  • Document and present billing discrepancies identified through audits
  • Route improper claim payments through the appropriate referral channels
  • Analyze error patterns involving medical records, billing documentation, and provider contract requirements
  • Prepare audit statistics and findings for accounts, regulatory agencies, and internal requesters
  • Work with the manager to update audit processes in response to clinical data review advances and cost-containment initiatives
  • Train new employees on departmental and audit procedures
  • Complete additional assignments as directed by the manager
  • Follow applicable laws, regulations, and organizational policies

Requirements

  • High school diploma or GED is required
  • A bachelor's degree in Health Information Management is preferred; relevant experience may substitute for the degree
  • At least three years of experience in a medical records department at an acute care hospital or other healthcare facility
  • Experience with DRG validation and ICD-10-CM training and education
  • RHIT or RHIA certification, or RN credentials with CCS certification
  • Knowledge of medical terminology, anatomy and physiology, disease pathogenesis and treatment, procedural drug therapies, and ancillary and diagnostic services
  • Understanding of utilization management principles
  • Knowledge of hospital structures and payment systems
  • Knowledge of Centers for Medicare and Medicaid prospective payment system regulations
  • Familiarity with ACCESS Software is preferred
  • Strong verbal and written communication skills
  • Proficiency with PCs and Microsoft Office, including Excel, Word, and PowerPoint
  • Professional and ethical conduct with adherence to company standards
  • Effective time management, prioritization, and delivery of accurate work on schedule
  • Ability to perform in a production-focused environment
  • Ability to ask probing questions and gather complete, relevant information
  • Willingness to cross-train and support cross-training in other roles and duties
  • Strong attention to detail, organization, and data processing skills
  • Ability to follow detailed instructions
  • Problem-solving, analytical, and research capabilities
  • Willingness and ability to work in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

Benefits

  • Medical, dental, and vision coverage
  • Retirement plan options
  • Generous paid time off
  • Incentive plan opportunities
  • Wellness programs
  • Paid volunteer time off
  • Tuition reimbursement
  • Work that directly contributes to improving lives
  • A mission-focused organization that values expertise, collaboration, and professional growth

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