Nurse Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct thorough charge audits for both inpatient and outpatient services.

• Examine itemized billing statements against medical records to ensure accuracy and completeness.

• Identify and document missing, duplicate, unsupported, or non-compliant charges.

• Validate charges in accordance with clinical documentation, coding regulations, and billing guidelines.

• Ensure that billing practices comply with CMS and payer requirements, national healthcare billing audit standards, and organizational compliance policies.

• Deliver clear and actionable audit findings to revenue cycle teams for necessary corrections and rebilling.

• Analyze audit results to uncover root causes and trends.

• Maintain precise, traceable, and defensible audit documentation.

• Monitor audit outcomes and their financial implications.

• Assist in formulating recommendations to enhance charge capture accuracy and billing procedures.

• Collaborate with coding and billing teams, clinical departments, and revenue cycle leadership.

• Provide expert guidance on documentation requirements, charge capture methodologies, and billing compliance standards.

• Support educational initiatives to mitigate recurring audit issues.

⛳️ Requirements

• Current Registered Nurse (RN) license or Licensed Practical Nurse (LPN) license.

• Minimum of 5 years of clinical nursing experience, preferably in ICU, ED, OR, or acute care settings.

• Proven experience in conducting charge audits, chart reviews, and billing validation.

• Strong grasp of medical record documentation and hospital billing processes.

• Familiarity with CPT, HCPCS, and basic ICD-10 coding.

• Understanding of revenue codes and charge capture methodologies.

• Knowledge of inpatient and outpatient billing regulations.

• Awareness of Medicare, Medicaid, and commercial payer billing guidelines.

• Familiarity with CMS regulations and compliance requirements.

• Ability to interpret itemized bills, clinical documentation, and diagnostic reports.

• Skill in identifying discrepancies and determining appropriate billing practices.

• Experience with EHR systems such as Epic, Cerner, or Meditech.

• Proficiency in using audit or billing tools and data systems.

• Strong analytical and critical thinking abilities.

• Exceptional attention to detail and accuracy.

• Capability to work independently and manage multiple priorities.

• Clear and professional written and verbal communication skills.

• Ability to convert complex findings into actionable recommendations.

• Prior experience in revenue integrity or healthcare auditing is preferred.

• Experience with denials or utilization review is a plus.

• Familiarity with DRG concepts (MS-DRG or APR-DRG) is preferred.

• Understanding of audit or compliance programs is advantageous.

• Experience in educating staff or facilitating process improvements is preferred.

🏝️ Benefits

• Comprehensive medical, dental, vision, and life insurance.

• Short-term and long-term disability coverage.

• 401(K) retirement plan.

• Referral bonuses.

• Opportunities for training and professional development.

• Reimbursement for professional certifications.

• Recognition on birthdays.

• Holiday gift selections.

• Performance awards.

• Awards for years of service.