Revenue Integrity Clinical Nurse Auditor
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Job Description
Revenue Integrity Clinical Nurse Auditor leveraging clinical knowledge for charge capture optimization. Collaborating with various medical departments to ensure accurate documentation and claims submission.
Responsibilities:
- Leverages clinical knowledge and documentation review to ensure appropriate charge capture and revenue optimization.
- Performs routine chart audit and clinical documentation review to identify missing, incorrect, or undocumented charges across clinic, hospital, and ancillary departments.
- 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.
Requirements:
- Bachelors Degree in Nursing from an accredited college or university.
- 2 or more years of experience in utilization review, clinical review, or authorizations.
- 4 or more years EPIC experience preferred.
- 4 or more years Coding experience and/or CPC or CPC-A coding certification preferred.
- Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing current State RN license required.
Benefits:
- The health system is an equal employment opportunity employer.
- Provides reasonable accommodations to qualified individuals with disabilities.
- Opportunities for ongoing education and feedback.
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