Nurse Auditor

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