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Nurse Auditor Revenue Integrity Specialist
Job Location:
Job Location:
Chesapeake, VA - USA
Monthly Salary:
Not provided by the employer
Monthly Salary:
Posted:
27 August 2026 (30+ days ago)
Posted:
Application Deadline:
24 November 2026
Application Deadline:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
Essential Duties and Responsibilities
These duties and responsibilities described below 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 schedule permits.
- Assist Patient Account personnel with patient questions about itemized charges.
- Maintain reporting systems for audit activities and identify patterns and trends in results.
- Act as a resource for all hospital departments regarding 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 processes and procedures.
- Work cooperatively with the Patient Accounting staff and other healthcare 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 and 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 HCPCS 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 monies and appropriate regulatory agencies.
- Educate Provider Services Claims Recovery Finance and other department staff on audit outcomes 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 questioning their bills. Must be able to communicate effectively both verbally and in writing with clinical and non-clinical staff and individuals.
- Be familiar with coding diagnostic and procedural information from the medical 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 orientation in-services educational meetings and other meetings as required.
- Attend continuing education functions as necessary to maintain credentials regardless of whether 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 for others in adherence to the Hospitals mission philosophy and policies for promoting a positive work and customer environment.
- Adhere to CRMCs confidentiality policy for all information related to patients families and friends hospital employees physicians and clients.
- Maintain effective interdepartmental communication.
- Attend required hospital-wide orientations meetings and in-services.
- Demonstrate a commitment to flexible work scheduling when necessary.
Minimum Required Education: Graduate of an approved school of professional nursing.
Preferred Education: Bachelor of Science in Nursing (BSN) preferred.
Experience: Senior-level coding experience with at least five years of recent coding experience in an acute hospital setting is required with coding ability demonstrated through a skills assessment; or five years of experience as an intensive care unit nurse emergency department nurse or documentation specialist nurse auditor.
Experience with health information systems and computer technology is required.
Must possess the ability to communicate effectively both verbally and in writing and work independently with strong attention to detail and accuracy.
Certificates Licenses Registrations
- Current Virginia Registered Nurse (RN) License.
Required Experience:
IC
About Company
Chesapeake Regional Healthcare is a health system laser-focused on innovation, known for making medical history in the region and providing patients with truly personal care. Its hospital, Chesapeake Regional Medical Center, is the only independent, community-based acute care hospital ... View more
