Position Summary / Career Interest:

The Revenue Integrity Clinical Nurse Auditor leverages clinical knowledge and documentation review to ensure appropriate charge capture and revenue optimization. Responsibilities include leveraging Epic technology and analytics to identify Revenue Integrity trends and investigate areas of revenue leakage, monitor financial performance, and work with IT to build mistake-proofing into the Epic system. The nurse auditor will work with clinical teams, compliance and other departments within Revenue Cycle to provide documentation and charging education and maximize system efficiency, timely and complete charge capture, and submission of clean claims to payors to drive financial performance.


Responsibilities and Essential Job Functions

• Responsible for identifying, building, and maintaining Revenue Guardian edits within the Epic billing system based on documentation and CDM review.
• Performs routine chart audit and clinical documentation review to identify missing, incorrect, or undocumented charges across clinic, hospital, and ancillary departments.
• Works with clinical, financial, and operational stakeholders to stand up accurate and complete charging and coding for new and emerging therapies and services and high-risk/high-dollar services provided.
• Uses clinical expertise to perform ongoing reviews of medical record documentation and clinical pertinence in accordance with peer standards and Medicare Regulations.
• Monitors and tracks KPIs such as missing and late charges, charge lag, daily revenue, DFNB days/days to timely bill, and clinically triggered charges.
• Supports process improvement activities to assure medical record compliance with regulatory and accreditation bodies.
• Monitors denial trends related to upstream set-up issues and acts as a liaison across departments to find solutions.
• Assists with the development, implementation, and testing process improvement and associated technical solutions.
• Aligns with CDI, Coding, and Revenue Cycle Insurance follow-up teams to reduce denials and influence proactive revenue optimization.
• Provides ongoing education and feedback to improve documentation in support of accurate charge capture, coding, and final claim submission.
• Leverages artificial intelligence (AI), system automation and analytics to identify and prioritize revenue leakage across the health system.
• Works effectively with ambulatory & IT, physicians, clinics, and all hospital clinical areas to resolve charge capture and process gaps.
• Works effectively with Revenue Integrity Charge Analysts, CDM, and Pricing Committees.
• Demonstrates knowledge of Coding Guidelines and Conventions (CPT/HCPCS, ICD-10-CM/PCS).
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree in Nursing from an accredited college or university.
• 2 or more years of experience in utilization review, clinical review, or authorizations

Preferred Education and Experience

• 4 or more years EPIC experience
• 4 or more years Coding experience and/or CPC or CPC-A coding certification

Required Licensure and Certification

• Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing Current State RN license

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.