Nurse Auditor

We are seeking a detail-oriented Registered Nurse (RN) Auditor to support revenue integrity efforts with a focus on charge audit and billing validation. In this role, you will review medical records and itemized bills to ensure charges are accurate, properly documented, and compliant with payer and regulatory requirements. Your work will help reduce financial risk, prevent denials, and strengthen accurate, defensible billing practices while supporting overall revenue and compliance goals.

Key Responsibilities

Charge Audit & Billing Validation (Primary Focus)

Perform comprehensive charge audits for inpatient and outpatient services.

Review itemized billing statements against medical records to verify accuracy and completeness.

Identify and document

Missing charges

Duplicate charges

Unsupported or non-compliant charges

Validate charges based on clinical documentation, coding rules, and billing guidelines.

CMS and payer requirements

National healthcare billing audit guidelines

Organizational compliance standards

Submit clear, actionable audit findings to revenue cycle teams for correction and rebilling.

Audit Analysis & Documentation

Analyze audit findings to determine root causes and patterns.

Maintain accurate audit documentation that is clear, traceable, and defensible.

Track audit outcomes and financial impact.

Assist in developing recommendations to improve charge capture accuracy and billing processes.

Partner with

Coding and billing teams

Clinical departments

Revenue cycle leadership

Documentation requirements

Charge capture practices

Billing compliance standards

Required Qualifications

Active Registered Nurse (RN) license or LPN license

5+ years of clinical nursing experience (ICU, ED, OR, or acute care preferred)

Experience performing

Charge audits

Chart reviews

Billing validation

Strong understanding of: Medical record documentation & Hospital billing processes

Technical Knowledge & Skills

Knowledge of

CPT, HCPCS, ICD-10 coding basics

Revenue codes and charge capture processes

Inpatient and outpatient billing rules

Familiarity with

Medicare, Medicaid, and commercial payer billing guidelines

CMS regulations and compliance expectations

Ability to

Interpret itemized bills, clinical documentation, and diagnostic reports

Identify discrepancies and determine correct billing practices

Experience using

EHR systems (Epic, Cerner, Meditech)

Audit or billing tools/data systems

Core Competencies

Strong analytical and critical thinking skills

High attention to detail and accuracy

Ability to work independently and manage priorities

Clear and professional written and verbal communication

Ability to translate complex findings into actionable insights