Nurse Auditor

Job description

We are seeking a detail-oriented Registered Nurse (RN) Auditor to support revenue integrity efforts with a focus on charge audit and billing validation. In this role, you will review medical records and itemized bills to ensure charges are accurate, properly documented, and compliant with payer and regulatory requirements. Your work will help reduce financial risk, prevent denials, and strengthen accurate, defensible billing practices while supporting overall revenue and compliance goals. **Key Responsibilities** **Charge Audit & Billing Validation (Primary Focus)** - 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 charges - Duplicate charges - Unsupported or non-compliant charges - Validate charges based on clinical documentation, coding rules, and billing guidelines. - Ensure all billing aligns with: - CMS and payer requirements - National healthcare billing audit guidelines - Organizational compliance standards - Submit clear, actionable audit findings to revenue cycle teams for correction and rebilling. **Audit Analysis & Documentation** - Analyze audit findings to determine root causes and patterns. - Maintain accurate audit documentation that is clear, traceable, and defensible. - Track audit outcomes and financial impact. - Assist in developing recommendations to improve charge capture accuracy and billing processes. **Collaboration & Education** - Partner with: - Coding and billing teams - Clinical departments - Revenue cycle leadership - Provide guidance on: - Documentation requirements - Charge capture practices - Billing compliance standards - Support education efforts to prevent recurring audit issues. **Required Qualifications** - 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 - Billing validation - Strong understanding of: Medical record documentation & Hospital billing processes **Technical Knowledge & Skills** - Knowledge of: - CPT, HCPCS, ICD-10 coding basics - Revenue codes and charge capture processes - Inpatient and outpatient billing rules - Familiarity with: - Medicare, Medicaid, and commercial payer billing guidelines - CMS regulations and compliance expectations - Ability to: - Interpret itemized bills, clinical documentation, and diagnostic reports - Identify discrepancies and determine correct billing practices - Experience using: - EHR systems (Epic, Cerner, Meditech) - Audit or billing tools/data systems **Core Competencies** - 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 **Preferred Experience** - Prior experience in: - Revenue integrity or healthcare auditing - Denials or utilization review - Familiarity with: - DRG concepts (MS-DRG or APR-DRG) - Audit or compliance programs - Experience educating staff or supporting process improvements **About UASI** UASI is the employer of choice due to our outstanding reputation for excellence within the industry and for our comprehensive benefit package which includes: - Medical, dental, vision and life insurance, short/long-term disability, 401(K) and referral bonuses - Training opportunities and reimbursement for professional certifications - UASI's unique approach to employee appreciation which include: birthday recognition, holiday gift selections, performance awards, and years of service awards