Nurse Auditor Revenue Integrity Specialist

Chesapeake Regional Healthcare; Chesapeake (VA); On-site; USD 65,000 - 90,000; Full time

Job summary

Chesapeake Regional Healthcare is seeking a dedicated health care professional for coordinating patient billing audits in Chesapeake, Virginia. This role requires at least five years of senior coding experience in a hospital setting and effective communication skills.

The ideal candidate will maintain a reporting system for audit activities and educate staff on charging protocols, ensuring accuracy and compliance in medical coding. Candidates must possess a Current Virginia RN License and have a commitment to high-quality patient care.

Qualifications

• Minimum of five years of senior-level coding experience in an acute hospital setting.
• Must have a Current Virginia RN License.
• Ability to work independently with strong attention to detail.

Responsibilities

• Coordinate and supervise patient bill audits.
• Assist patients with questions about charges.
• Maintain audit activity reporting systems.
• Provide educational sessions on charging procedures.

Skills

Coding accuracy

Effective communication

Attention to detail

Customer relations

Education

Bachelor of Science in Nursing

Graduate of an approved school of professional Nursing

Tools

Health information systems

ICD-10-CM

CPT-4/HCPCS

Job description

Essential Duties and Responsibilities

These duties and responsibilities represent the general tasks performed on a daily basis; other tasks may be assigned.

• Coordinate, supervise, and respond to third‑party patient bill audits. Perform patient requested audits in a timely manner. Perform random quality audits as scheduled.
• Assist Patient Account personnel with patient questions about itemized charges.
• Maintain a reporting system of audit activities and identify patterns and trends of results.
• Act as a resource for all hospital departments with charging questions and issues.
• Routinely review inpatient and outpatient records for appropriate coding and charging.
• Provide educational sessions for revenue‑producing departments regarding appropriate charging process and procedures.
• Work cooperatively with the Patient Accounting staff and other health‑care professionals in obtaining correct HCPCS codes and modifiers.
• Assist the Health Information Department with RAC requests, coding reviews, and denials.
• Ensure accuracy and integrity of charge data prior to billing interface and claims submission.
• Utilize a computerized encoding system to facilitate accurate coding; sequence diagnoses and procedures by following ICD‑10‑CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Report trends and improvements to the Director of Patient Accounts regarding assigned HCPC codes and modifiers.
• Receive, review, verify, and process requests for chart audits of inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims departments.
• Prepare written reports for finance and claims departments including explanations for recovery of money and appropriate regulatory agencies.
• Educate provider services, claims, recovery, finance and other department staff on the outcomes of the audit results and assist provider services with educational efforts.
• Provide feedback and process improvement recommendations to appropriate hospital departments and committees based on analysis and trending of hospital or provider audits.
• Provide written explanations to patients who are questioning their bills. Must communicate effectively verbally and in written format to clinical and non‑clinical staff and individuals.
• Be familiar with coding diagnostic and procedural information from the record using ICD‑10‑CM and CPT‑4/HCPCS classification systems. Utilize a computerized encoding system to facilitate accurate coding. Sequence diagnoses and procedures by following ICD‑10‑CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Consistently maintain established productivity requirements and achieve a 96 % or greater accuracy rate.
• Attend hospital‑wide orientations, in‑services, educational meetings, and other meetings as required.
• Attend other continuing education functions as necessary to maintain credentials, regardless of whether the educational programs are supported by the Department budget.
• Exhibit excellent customer relations with patients, visitors, physicians, and co‑workers.
• Show courtesy, compassion, honesty, and respect to others in the adherence to the Hospital's mission, philosophy, and policy for promoting a positive work and customer environment.
• Adhere to CRMC's confidentiality policy for all information related to patients, families and friends, hospital employees, physicians and clients.
• Maintain effective interdepartmental communication.
• Demonstrate a commitment to flexible work scheduling when necessary.

Education and Experience

Minimum Required Education: Graduate of an approved school of professional Nursing.

Preferred Education: Bachelor of Science in Nursing.

Experience: Senior‑level coding experience of at least five years. Recent experience coding in an acute hospital setting required, with coding ability demonstrated via a skills assessment or five years as an intensive care unit, emergency department or documentation specialist nurse auditor. Experience with health information systems and computer technology required. Ability to communicate effectively, both verbally and in written format. Must work independently with attention to detail and accuracy.

Certificates, Licenses, Registrations

Current Virginia RN License.