The University of Kansas Hospital
Revenue Integrity Clinical Nurse Auditor
The University of Kansas Hospital, Kansas City, Kansas, United States, 66115
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.
Responsibilities Job ID:
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.
Required Education and Experience
Bachelor’s Degree in Nursing from an accredited college or university.
2 or more years of experience in utilization review, clinical review, or authorizations.
Preferred Education and Experience
4 or more years of Epic experience.
4 or more years of coding experience and/or CPC or CPC-A coding certification.
Required Licensure and 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 orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.
Benefits
Robust medical, dental and vision package with options for families.
Life, disability, and accident insurance plus voluntary offerings such as critical illness insurance and identity theft protection.
Comprehensive wellness program and Employee Assistance Program (EAP) with free counseling sessions and legal advice options.
Tuition reimbursement for formal education credits.
401(a) retirement savings plan with employer contribution.
Success Profile
Accountable to Team
Takes Initiative
Possesses Integrity
Desire to Grow & Develop
Our Culture
Work with a team that supports you and feels you belong, empowering staff to put the patient first in all things.
Every employee makes an impact, regardless of role – we all contribute to patient care.
Leadership is approachable, open-minded, and adaptable to challenges in healthcare.
We value diversity and inclusion, reflecting these values internally and externally.
Our resources, culture, and commitment to quality allow staff to provide exceptional care.
We welcome patients and cases that other hospitals cannot, demonstrating our passion to challenge ourselves and be the best.
We are a leader in the region, rooted in experience and excellence.
We offer unique professional development opportunities and convenient pathways for continuing education.
We make a difference in our communities by improving health and lives.
#J-18808-Ljbffr
Responsibilities Job ID:
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.
Required Education and Experience
Bachelor’s Degree in Nursing from an accredited college or university.
2 or more years of experience in utilization review, clinical review, or authorizations.
Preferred Education and Experience
4 or more years of Epic experience.
4 or more years of coding experience and/or CPC or CPC-A coding certification.
Required Licensure and 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 orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.
Benefits
Robust medical, dental and vision package with options for families.
Life, disability, and accident insurance plus voluntary offerings such as critical illness insurance and identity theft protection.
Comprehensive wellness program and Employee Assistance Program (EAP) with free counseling sessions and legal advice options.
Tuition reimbursement for formal education credits.
401(a) retirement savings plan with employer contribution.
Success Profile
Accountable to Team
Takes Initiative
Possesses Integrity
Desire to Grow & Develop
Our Culture
Work with a team that supports you and feels you belong, empowering staff to put the patient first in all things.
Every employee makes an impact, regardless of role – we all contribute to patient care.
Leadership is approachable, open-minded, and adaptable to challenges in healthcare.
We value diversity and inclusion, reflecting these values internally and externally.
Our resources, culture, and commitment to quality allow staff to provide exceptional care.
We welcome patients and cases that other hospitals cannot, demonstrating our passion to challenge ourselves and be the best.
We are a leader in the region, rooted in experience and excellence.
We offer unique professional development opportunities and convenient pathways for continuing education.
We make a difference in our communities by improving health and lives.
#J-18808-Ljbffr