Job Description:
• Perform comprehensive charge audits for inpatient and outpatient services
• Review itemized billing statements against medical records to verify accuracy and completeness
• Identify and document missing, duplicate, unsupported, or non-compliant charges
• Validate charges based on clinical documentation, coding rules, and billing guidelines
• Ensure billing aligns with CMS and payer requirements, national healthcare billing audit guidelines, and organizational compliance standards
• Submit clear, actionable audit findings to revenue cycle teams for correction and rebilling
• Analyze audit findings to determine root causes and patterns
• Maintain accurate, traceable, and defensible audit documentation
• Track audit outcomes and financial impact
• Assist in developing recommendations to improve charge capture accuracy and billing processes
• Partner with coding and billing teams, clinical departments, and revenue cycle leadership
• Provide guidance on documentation requirements, charge capture practices, and billing compliance standards
• Support education efforts to prevent recurring audit issues
Requirements:
• Active Registered Nurse (RN) license or LPN license
• 5+ years of clinical nursing experience (ICU, ED, OR, or acute care preferred)
• Experience performing charge audits, chart reviews, and billing validation
• Strong understanding of medical record documentation and hospital billing processes
• Knowledge of CPT, HCPCS, and ICD-10 coding basics
• Knowledge of revenue codes and charge capture processes
• Knowledge of inpatient and outpatient billing rules
• Familiarity with Medicare, Medicaid, and commercial payer billing guidelines
• Familiarity with CMS regulations and compliance expectations
• Ability to interpret itemized bills, clinical documentation, and diagnostic reports
• Ability to identify discrepancies and determine correct billing practices
• Experience using EHR systems, including Epic, Cerner, or Meditech
• Experience using audit or billing tools/data systems
• Strong analytical and critical thinking skills
• High attention to detail and accuracy
• Ability to work independently and manage priorities
• Clear and professional written and verbal communication
• Ability to translate complex findings into actionable insights
• Prior revenue integrity or healthcare auditing experience preferred
• Denials or utilization review experience preferred
• Familiarity with DRG concepts (MS-DRG or APR-DRG) preferred
• Familiarity with audit or compliance programs preferred
• Experience educating staff or supporting process improvements preferred
Benefits:
• Medical, dental, vision and life insurance
• Short/long-term disability
• 401(K)
• Referral bonuses
• Training opportunities
• Reimbursement for professional certifications
• Birthday recognition
• Holiday gift selections
• Performance awards
• Years of service awards
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