Compliance Auditor Registered Nurse Revenue Cycle Baptist Jacksonville

Baptist Health (Jacksonville); Tallahassee (FL); Remoto; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk.

The ideal candidate will have a strong clinical nursing background combined with experience in healthcare

Competenze

• Bachelor's degree required.
• Active RN license required.
• Five or more years of clinical nursing experience required.
• Five or more years of healthcare experience required.
• Experience conducting audits, compliance reviews, clinical documentation reviews, revenue integrity audits, quality audits, or related healthcare auditing activities preferred.
• Experience with medical coding, facility coding, DRG validation, clinical documentation improvement (CDI), utilization review, case management, quality, or revenue cycle operations strongly preferred.
• Strong knowledge of healthcare compliance, clinical documentation standards, reimbursement methodologies, regulatory requirements, and auditing principles.
• Experience performing root cause analysis and developing corrective action plans.
• Excellent analytical, written communication, presentation, and report-writing skills.

Mansioni

• Conduct compliance, clinical, and revenue cycle audits across hospital service lines, new locations, workplans, and ad hoc audit requests.
• Review medical record documentation, charges, and coding to ensure accuracy, completeness, and regulatory compliance.
• Audit facility coding and DRG assignments to identify coding, billing, reimbursement, and documentation concerns.
• Analyze audit findings to identify control gaps, process inefficiencies, compliance risks, and opportunities for process improvement.
• Perform root cause analysis to determine underlying causes of audit findings and recommend corrective actions.
• Collaborate with operational, clinical, and program leadership to develop and monitor action plans that improve compliance and strengthen internal controls.
• Prepare clear, concise audit reports and communicate findings and recommendations to leadership and key stakeholders.
• Verify completion and effectiveness of corrective action plans and ongoing compliance initiatives.
• Maintain current knowledge of healthcare regulations, documentation standards, coding guidelines, reimbursement methodologies, payer requirements, and auditing practices.

Conoscenze

Analytical skills

Written communication

Presentation skills

Report-writing

Audit experience

Formazione

Bachelor's degree

RN license

Strumenti

Epic

Descrizione del lavoro

About Baptist Health

Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children’s Hospital.

Job Summary

Baptist Health is seeking a Compliance Auditor (RN) to support compliance, clinical, and revenue-focused auditing activities across hospital service lines. This role partners closely with operational and clinical leadership to evaluate documentation, coding accuracy, regulatory compliance, and internal controls while identifying process improvement opportunities and mitigating organizational risk. The ideal candidate will have a strong clinical nursing background combined with experience in healthcare auditing, revenue integrity, compliance, or coding.

Key Responsibilities

• 1. Conduct compliance, clinical, and revenue cycle audits across hospital service lines, new locations, workplans, and ad hoc audit requests.
• 2. Review medical record documentation, charges, and coding to ensure accuracy, completeness, and compliance with regulatory and organizational requirements.
• 3. Audit facility coding and DRG assignments to identify coding, billing, reimbursement, and documentation concerns.
• 4. Analyze audit findings to identify control gaps, process inefficiencies, compliance risks, and opportunities for process improvement.
• 5. Perform root cause analysis to determine underlying causes of audit findings and recommend corrective actions.
• 6. Collaborate with operational, clinical, and program leadership to develop and monitor action plans that improve compliance and strengthen internal controls.
• 7. Prepare clear, concise audit reports and communicate findings and recommendations to leadership and key stakeholders.
• 8. Verify completion and effectiveness of corrective action plans and ongoing compliance initiatives.
• 9. Maintain current knowledge of healthcare regulations, documentation standards, coding guidelines, reimbursement methodologies, payer requirements, and auditing practices.

Minimum Qualifications

• 1. Bachelor's degree required.
• 2. Active Registered Nurse (RN) license required.
• 3. Five or more years of clinical nursing experience required.
• 4. Five or more years of healthcare experience required.
• 5. Experience conducting audits, compliance reviews, clinical documentation reviews, revenue integrity audits, quality audits, or related healthcare auditing activities preferred.
• 6. Experience with medical coding, facility coding, DRG validation, clinical documentation improvement (CDI), utilization review, case management, quality, or revenue cycle operations strongly preferred.
• 7. Strong knowledge of healthcare compliance, clinical documentation standards, reimbursement methodologies, regulatory requirements, and auditing principles.
• 8. Experience performing root cause analysis and developing corrective action plans.
• 9. Excellent analytical, written communication, presentation, and report-writing skills.

Preferred Qualifications

• 1. Experience in hospital compliance, revenue integrity, CDI, utilization management, quality improvement, or clinical auditing.
• 2. Certifications such as CCDS, CDIP, CPC, CCS, RHIA, RHIT, CHC, CPHQ, or related credentials preferred.
• 3. Experience working with Epic and other healthcare information systems preferred.

Primary Location

Remote - Florida 123 Remote St Tallahassee, FL 32301 United States of America