Nurse Auditor

Work from home Full-time role Hiring

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:

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