Nurse Auditor - OP/ IP

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Job Summary

The Nurse Auditor is responsible for reviewing and validating charge capture accuracy and inpatient procedure charges to ensure compliance with organizational policies, coding guidelines, billing regulations, and payer requirements. This position supports revenue integrity initiatives by identifying charging discrepancies, documenting findings, and collaborating with operational teams to improve charge accuracy.

Key Responsibilities

• Review inpatient accounts to validate documentation and charge capture completeness and accuracy.
• Audit inpatient procedure charges against clinical documentation and applicable charging guidelines.
• Identify missing, duplicate, incorrect, or unsupported documentation
• Document audit findings and communicate discrepancies to appropriate stakeholders.
• Assist with charge reconciliation and correction processes.
• Support compliance with federal, state, payer, and organizational billing requirements.
• Maintain productivity and quality standards established by the department.
• Participate in training and continuous improvement initiatives.
• Prepare audit reports and maintain accurate records of findings.

Qualifications

• Bachelor of Science in Nursing (BSN).
• Basic understanding of healthcare revenue cycle, billing, coding, or clinical documentation preferred.
• Strong analytical and attention-to-detail skills.
• Proficiency in Microsoft Office applications, particularly Excel.
• Effective written and verbal communication skills.
• Ability to work independently and as part of a team.

Preferred Qualifications

• Experience in healthcare operations, revenue cycle, charge capture, medical records, coding, or auditing.
• Knowledge of inpatient hospital billing and charging processes.

Experience

• 0 to 2 years of healthcare auditing, revenue cycle, billing, coding, or related experience.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.