Revenue Integrity Clinical Nurse Auditor

Revenue Integrity Clinical Nurse Auditor

Our nurses are leaders and decision makers, working closely with physicians to provide the best care and most advanced treatments. On our team, you’ll work in an environment of respect and professionalism, and you’ll have the support to advance your nursing career in the direction you choose. Find out more about the wide variety of opportunities for nurses at The University of Kansas Health System.

Job : R-49293 Job Type: Full time Location: Kansas City, Kansas

Position Summary / Career Interest: The Revenue Integrity Clinical Nurse Auditor leverages clinical knowledge and documentation review to ensure appropriate charge capture and revenue optimization. Responsibilities include leveraging Epic technology and analytics to identify revenue integrity trends and investigate areas of revenue leakage, monitor financial performance, and work with IT to build mistake-proofing into the Epic system. The nurse auditor will work with clinical teams, compliance and other departments within Revenue Cycle to provide documentation, charging education, and maximize system efficiency, timely and complete charge capture, and submission of clean claims to payors to drive financial performance.

Responsibilities and

Essential Job Functions:

• Responsible for identifying, building, and maintaining Revenue Guardian edits within the Epic billing system based on documentation and CDM review.
• Performs routine chart audit and clinical documentation review to identify missing, incorrect, or undocumented charges across clinic, hospital, and ancillary departments.
• Works with clinical, financial, and operational stakeholders to stand up accurate and complete charging and coding for new and emerging therapies and services and high-risk/high-dollar services provided.
• Uses clinical expertise to perform ongoing reviews of medical record documentation and clinical pertinence in accordance with peer standards and Medicare Regulations.
• Monitors and tracks KPIs such as missing and late charges, charge lag, daily revenue, DFNB days/days to timely bill, and clinically triggered charges.
• Supports process improvement activities to assure medical record compliance with regulatory and accreditation bodies.
• Monitors denial trends related to upstream set-up issues and acts as a liaison across departments to find solutions.
• Assists with development, implementation, and testing of process improvement and associated technical solutions.
• Aligns with CDI, Coding, and Revenue Cycle Insurance follow-up teams to reduce denials and influence proactive revenue optimization.
• Provides ongoing education and feedback to improve documentation in support of accurate charge capture, coding, and final claim submission.
• Leverages AI, system automation and analytics to identify and prioritize revenue leakage across the health system.
• Works effectively with ambulatory & IT, physicians, clinics, and all hospital clinical areas to resolve charge capture and process gaps.
• Works effectively with Revenue Integrity Charge Analysts, CDM, and Pricing Committees.
• Demonstrates knowledge of Coding Guidelines and Conventions (CPT/HCPCS, ICD-10-CM/PCS).
• Must be able to perform the professional, clinical and/or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary depending on your department or unit. Other duties may be assigned as required.

• Bachelor’s Degree in Nursing from an accredited college or university.
• 2 or more years of experience in utilization review, clinical review, or authorizations.

• 4 or more years of Epic experience.
• 4 or more years of coding experience and/or CPC or CPC-A coding certification.

• Licensed Registered Nurse (LRN) – Multi‑State – State Board of Nursing Current State RN license.

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual…