Audits zero-balance hospital accounts to identify underpaid inpatient and outpatient claims. Reviews payer contracts, medical records, policies, regulations, and payment data; models reimbursement methodologies; researches underpayment trends; and develops audit plans, pricing documents, and technical procedures using Excel, Access, and SQL. Senior auditors lead complex investigations, provide quality reviews, mentor staff, and recommend process improvements.

Supervise DRG coding audits, ensuring compliance with coding guidelines, provide training, conduct quality assurance, and generate reports for clients.