Horizon Blue Cross Blue Shield of New Jersey
DRG Validation Auditor
5 days agoWhat's your preference?
Job Description
- Req#: 2019-10543
Employer Industry: Health Insurance
Why consider this job opportunity:
- Salary up to $104,370
- Comprehensive health benefits including Medical, Dental, and Vision
- Generous Paid Time Off (PTO) and retirement plans
- Incentive plans and wellness programs available
- Opportunities for professional development with tuition reimbursement
- Paid Volunteer Time Off to support community engagement
What to Expect (Job Responsibilities):
- Lead audits of hospital billing and coding practices and conduct desk audits
- Identify and present billing discrepancies during audits and coordinate referral of improper claim payments
- Compile statistics and audit information for presentation to accounts and regulatory agencies
- Review and update audit processes in line with new innovations and company initiatives
- Train new staff on department and audit procedures
What is Required (Qualifications):
- Minimum educational requirement: High School Diploma or GED
- Bachelor’s degree in Health Information Management preferred, or relevant experience in lieu of degree
- Minimum of 3 years of experience in a medical records department of an acute care hospital or healthcare facility
- Required licensing: RHIT, RHIA, or RN with CCS
- Experience with DRG validation and ICD-10-CM/PCS training and education
How to Stand Out (Preferred Qualifications):
- CCS, CCS-P, or CCA certifications for those with RHIT or RHIA credentials
- Knowledge of ACCESS Software
- Strong analytical, research, and problem-solving skills
- Proven ability to manage multiple priorities in a fast-paced environment
- Effective verbal and written communication skills with a focus on teamwork
#HealthInsurance #Auditing #CareerOpportunity #CompetitivePay #ProfessionalDevelopment
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Horizon BCBSNJ offers affordable New Jersey healthcare and health insurance for individuals, families and employers. Find cheap NJ health insurance quotes online from Horizon BCBSNJ website, an independent licensee of the BCBS Association.
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