Quality Auditor, Hospital Bill Audits & Itemized Bill Review (Program Integrity)

Oversee QA of inpatient and outpatient hospital bill audits and itemized bill reviews; validate that audit findings are supported by documentation, align with payer policies and reimbursement requirements, and are defensible. Identify opportunities to improve audit performance, reduce overturns, and strengthen workflows through structured QA, feedback, and trend reporting. Perform retrospective quality audits of audit cases, ensure accuracy of coding/billing, units, modifiers, and reimbursement calculations, and maintain quality dashboards. Provide structured coaching and CAP recommendations, participate in calibration sessions, and escalate high-risk issues as needed. Maintain documentation and templates to reduce variation and support defensibility; collaborate with audit teams to ensure consistent interpretation of billing criteria and policy standards.