Capital Health (US) · 2 months ago
Claims Integrity Auditor- Full Time, Day
Lawrenceville, NJ
Full-time
Onsite
Mid Level
$34.99/hr - $51.70/hr
3+ years expCapital Health is the region's leader in providing progressive, quality patient care. The Claims Integrity Auditor provides technical and analytical support for patient account billing analysis and evaluation, ensuring accuracy, compliance, and responsibility in billing processes.
Health CareMedicalOncology
Responsibilities
Serves in a quality capacity verifying all charges on a patient account and is well-versed in all areas of the chart in order to determine appropriate charges
Understands patient billing requirements and applies this knowledge during chart review in order to verify that all appropriate charges have been added and that all inappropriate charges are removed. Performs compliance audits of records to ensure documentation is present to support all charges posted to the patient account
Collaborates directly with nursing units, ancillary departments, directors, and managers related to charging to ensure compliance with Federal and State regulations and continuous quality improvement
Reviews charts for documentation-related quality concerns including unsupported charges and services and misuse of departmental billing processes
Reports discrepancies to appropriate directors and managers and ensures that corrective action is taken in a timely manner
Performs chart review to identify if variation from quality billing exists and if so, determines the need for peer review. Identifies concerns and make recommendations for review to improve the process. Communicates findings as appropriate to staff/departments involved
Coordinates and performs preliminary review of charts selected by third party payers to ensure documentation is appropriate. Reviews data for external and internal requirements. Resolves issues as required
Reviews audit results from third payers and supplies additional information if in disagreement with findings. Keeps department apprised of status and relays up-to-date statuses as required
Manages loggings, filing, and storage of audited Medicare and Managed Medicare records. Ensures integrity of data and corrects errors as needed
Performs other duties as assigned and adapts to changing departmental demands
Qualification
Required
Any healthcare technical license including Registered Nurse (RN), ARRT, or Registered Health Information Technician (RHIA/RHIT)
Three years of technical experience within a healthcare environment
Demonstrates excellent verbal and written communication skills
Strong data analysis and problem-solving skills
Proficient in basic computer applications such as Word, Excel, and PowerPoint
Must possess thorough knowledge of medical terminology, anatomy, and physiology
Understanding of ICD-9/ICD-10 and CPT coding classifications
Preferred
Previous auditing, medical claims analysis, or Health Information Management experience in a healthcare setting
Benefits
Medical Plan
Prescription drug coverage & In-House Employee Pharmacy
Dental Plan
Vision Plan
Flexible Spending Account (FSA)
Healthcare FSA
Dependent Care FSA
Retirement Savings and Investment Plan
Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
Disability Benefits – Long Term Disability (LTD)
Disability Benefits – Short Term Disability (STD)
Employee Assistance Program
Commuter Transit
Commuter Parking
Supplemental Life Insurance
Voluntary Life Spouse
Voluntary Life Employee
Voluntary Life Child
Voluntary Legal Services
Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
Voluntary Identity Theft Insurance
Voluntary Pet Insurance
Paid Time-Off Program
Company
Capital Health (US)
Capital Health is the region’s leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology.
1001-5000 employees
H1B Sponsorship
Capital Health (US) has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (1)
2023 (1)
2020 (1)
Funding
Current Stage
Late StageTotal Funding
$1MKey Investors
Bank of America
2023-05-03Grant· $0.5M
2022-10-13Grant· $0.5M
Leadership Team
Arlene Walsh
Chief Operating Officer
Stephen Miller, JD
Sr. Vice President, Chief Legal Officer
Recent News
The Philadelphia Inquirer
2025-09-02
Company data provided by crunchbase