Clinical Nurse Auditor
Dignity Health    •    Phoenix, AZ    •    Posted: 7/2/2014

Job Summary:

This position performs charge audits for pre and post go live EHR Readiness as well as charge optimization for all Dignity Health facilities. This position will work closely with various departments to verify services provided clinical documentation and charge capture are in alignment.. Communicate all audit findings with the necessary parties and work closely with IT Revenue Cycle to obtain resolution of findings.


* Audits are performed on clinical documentation against the charges captured to identify deficiencies Audit results are documented and shared with IT Revenue Cycle Teams for review and resolution. Auditors will continue communication until all discrepancies are resolved.

* Audits are performed on clinical documentation to identify missed charge capture opportunities.

* Provide recommendations for revenue optimization for future EHR Implementations, as well as existing Cerner locations.

* Charge reconciliation is required for all audits performed to ensure all over and under charges have been posted to the account. If needed, works with the posting unit for any issues identified in the reconciliation/posting process.

* Work with various departments to obtain the necessary information to perform account audits. This includes but is not limited to, Health Information Management department, Clinical units, Case Managers, and Physicians.

* Responsible for documenting all audit findings in both the Financial System and internal Audit Logs. Maintains all Clinical Audit reports and weekly production reports.

* Report any reoccurring charging issues that are identified to Management.

* Working knowledge of reimbursement systems (MS-DRGs/ AP-DRGs/APR-DRGS/APCs/RVRBS

* May perform educational services to clients based on audit results

* May have the opportunity to mentor other new nurse auditors

* Maintains current working knowledge of CPT and ICD coding principles, government regulation, protocols


Minimum Required:

* 3 years clinical RN

* 2 years, Charge Audit, or related experience
* AA Degree

* RN License


* 2 years UtilizationReview, Case Management or related experience

* Preferred coding skills: prospective payment methodologies

* 3+ years coding of experience including inpatient and/or outpatient coding skills as well as ambulatory surgery, APC, emergency room, evaluation and management, auditing, report-writing expertise

Special Knowledge, Skills, Abilities

* Knowledge of hospital billing and charging processes

* Understanding of Medical Terminology as well as an understanding of rules and guidelines to include American Association of Medical Audit Specialists (AAMAS), and National Commission on Insurance Guidelines and Medicare billing guidelines (CMS)

  • Requires proficiency with Cerner Clinical Applications including PowerChart

  • Requires proficiency with Excel, Word

  • Database tools such as Microsoft Access preferred


* 50% travel will be required to other Corporate Offices and hospitals

About Dignity Health

Dignity Health, one of the nation's five largest health care systems, is a 21-state network of nearly 9,000 physicians, 55,000 employees, and more than 380 care centers, including hospitals, urgent and occupational care, imaging centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality and affordable patient-centered care with special attention to the poor and underserved. In 2013, Dignity Health provided nearly $1.7 billion in charitable care and services. For more information, please visit our website at You can also follow us on Twitter and Facebook.



Employment Type: Full-Time
Base Pay: N/A
Other Pay: N/A
Industry: Healthcare - Health Services
Education: Not Specified
Experience: Not Specified
Manages Others: Not Specified
Relocation: Not Specified
Required Travel: Not Specified
Job ID: 1400009821

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