Kansas Health System is hiring a Revenue Integrity Clinical Nurse Auditor to harness clinical expertise for revenue optimization and accurate charge capture. In this role, you will review medical record documentation, build system edits, and collaborate across clinical, financial, and revenue cycle teams to drive financial performance through clean claim submission.
What You'll Do
- Identify, build, and maintain Revenue Guardian edits within the Epic billing system based on documentation and CDM review.
- Perform routine chart audits to identify missing, incorrect, or undocumented charges across clinic, hospital, and ancillary departments.
- Work with stakeholders to establish accurate charging and coding for new and emerging therapies and high-risk/high-dollar services.
- Use clinical expertise to perform ongoing reviews of medical record documentation in accordance with peer standards and Medicare Regulations.
- Monitor and track KPIs such as missing charges, charge lag, daily revenue, and DFNB days.
- Support process improvement activities to assure compliance with regulatory and accreditation bodies.
- Monitor denial trends related to upstream set-up issues and act as a liaison across departments to find solutions.
- Assist with the development, implementation, and testing of process improvements and associated technical solutions.
- Align with CDI, Coding, and Revenue Cycle Insurance follow-up teams to reduce denials and influence proactive revenue optimization.
- Provide ongoing education and feedback to improve documentation for accurate charge capture, coding, and final claim submission.
- Leverage artificial intelligence (AI), system automation, and analytics to identify and prioritize revenue leakage across the health system.
- Work effectively with ambulatory & IT, physicians, clinics, and all hospital clinical areas to resolve charge capture and process gaps.
- Work effectively with Revenue Integrity Charge Analysts, CDM, and Pricing Committees.
- Demonstrate knowledge of Coding Guidelines and Conventions (CPT/HCPCS, ICD-10-CM/PCS).
- Perform the professional, clinical and or technical competencies of the assigned unit or department.
What We're Looking For
- Bachelor's Degree in Nursing from an accredited college or university.
- 2 or more years of experience in utilization review, clinical review, or authorizations.
- Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing Current State RN license.
Nice to Have
- 4 or more years Epic experience.
- 4 or more years Coding experience and/or CPC or CPC-A coding certification.
Technical Stack
- Epic
- Revenue Guardian edits
- Analytics
Work Mode
This is a fully remote position.
The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status.
