Certified Hospital Claims Auditor

Job Summary

Providing clinical and technical analysis for hospital inpatient claims, the full-time Certified Hospital Claims Auditor will work remotely to ensure compliance with industry billing standards and resolve billing irregularities.

Key responsibilities

• Identifies billing irregularities on hospital bills and recommends solutions for resolution
• Communicates claim payment decisions and coordinates processes for reviewing large dollar hospital claims
• Develops and documents hospital claims review and audit policies while collaborating with other departments for accurate claims payment

Required qualifications

• 3 - 5 years of experience as a hospital billing coordinator and/or auditor
• Certified Professional Coder certification
• 2 years of health insurance industry experience, preferably in auditing hospital claims
• RN, LPN, or an associate's degree in nursing; BSN is desired
• Prior experience in reviewing medical records