Auditor

• Review clinical documentation, medical records, charges, and billing practices for accuracy, regulatory compliance, and appropriate reimbursement
• Evaluate coding, charging, documentation, and revenue cycle processes
• Identify opportunities for process improvement, staff education, and revenue optimization

Nurse Auditor, Revenue Integrity

• Review clinical documentation, medical records, charges, and billing practices
• Evaluate coding, charging, documentation, and revenue cycle processes
• Identify opportunities for process improvement, staff education, and revenue optimization
• Ensure accuracy, regulatory compliance, and appropriate reimbursement

• Coordinate revenue integrity and charge-related denials with the Patient Business Service center
• Ensure compliant and complete clinical documentation
• Assist with denials and related audits
• Identify opportunities for revenue optimization
• Perform thorough and routine chart reviews
• Provide education to clinical colleagues
• Track identified trends
• Apply clinical knowledge and standard procedures to address charge-related trends promptly
• Provide necessary education to responsible parties
• Perform retrospective charge reviews and assist with third-party charge audits
• Track Revenue Integrity-related audits and identify trends
• Collaborate with Revenue Integrity, PBS, and departmental colleagues on education and reporting to key stakeholders
• Serve as a resource contact, providing clinical information to colleagues and payers
• Collaborate with the Revenue Integrity team to improve and implement front-end denial-prevention processes
• May travel between regional locations