Job Summary
The Hospital Billing & Coding Auditor leads on-site and desk audits of hospital billing/coding practices, DRG validation, and utilization review. This role develops audit protocols, tracks trends, trains staff, and ensures compliance with ICD-10-CM, DRG assignment, and payer regulations while identifying billing discrepancies for recovery.

Key Responsibilities

• Conduct lead on-site hospital audits, desk audits, per diem bill verification, DRG validation (utilization review), and credit balance audits.

• Identify billing discrepancies, error trends in medical records/billing documentation, and contract misinterpretations; refer improper payments through proper channels.

• Compile audit statistics and present findings to accounts, regulatory agencies, and internal stakeholders.

• Design audit protocols, forms, and special projects; profile institutional audit trends.

• Review/update audit processes to align with clinical data innovations and cost containment goals.

• Train new staff on department/audit procedures and provide ICD-10-CM/DRG guidance to stakeholders.

• Handle special assignments and maintain compliance with applicable laws, regulations, and policies.

Minimum Qualifications

• High School Diploma/GED (Bachelor’s in Health Information Management preferred or equivalent experience).

• 3+ years in medical records department of acute care hospital/healthcare facility.

• Expertise in inpatient coding, DRG validation, ICD-10-CM training/education.

• CCS, RHIT, or RHIA certification required.

• Strong Microsoft Office skills (Excel, Word, PowerPoint).

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