Inpatient Hospital Auditor II

Company Name: Horizon BCBS
Job TitleInpatient Hospital Auditor II
Work Setting: On Site:  Newark, New Jersey
Job Function:  Inpatient Hospital Auditor
Job Type: Full Time


Horizon BCBSNJ is the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too.

Job Description:  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 units business.

Skills and Abilities:

  • Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
  • Demonstrated ability to deliver highly technical information to less technical individuals.
  • Must have strong PC skills experience with MICROSOFT office programs: excel, word and power point.
  • Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
  • Proven time management skills are necessary.
  • Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
  • Proven ability to ask probing questions and obtain thorough and relevant information.
  • Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
  • Must be detail oriented with strong organizational and data processing skills.
  • Proven ability to follow detailed instructions is essential, along with proven problem solving skills.
  • Proven analytical, research and problem solving skills a must.


  • Requires a Bachelor's degree in Health Information Management or related field, or RN with CCS certification.


  • 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.

Additional licensing, certifications, registrations:

  • Requires RHIT/RHIA certification; or RN license with CCS Certification;
  • Valid Driver’s license and access to a car.
  • Preferred CCS, CCS-P or CCA certifications

Benefits:  Competitive pay and benefits

Instructions for Resume Submission: