Clinical Revenue Auditor 251399

Clinical Revenue Auditor

Job ID: 251399

Client: Health System

Location: New York, NY 10017

Schedule: Regular Business Hours | 3 Days Onsite Per Week 2 Days Remote

Salary Range: $96,000 – $144,000 Annually

Compensation will be determined based on experience, education, certifications, and overall qualifications.

Position Overview

We are seeking a Clinical Revenue Auditor to join a growing Revenue Integrity team. This position plays a key role in ensuring accurate reimbursement, optimizing revenue capture, and maintaining billing compliance across a large healthcare system.

The ideal candidate will have a clinical background combined with experience in auditing, revenue cycle operations, medical coding, charge capture, or revenue integrity. Candidates with RN experience and a strong understanding of healthcare operations are highly encouraged to apply.

This role partners closely with clinical, coding, billing, and operational teams to identify revenue opportunities, resolve documentation and billing issues, and improve overall revenue cycle performance.

Key Responsibilities

• Conduct clinical and charge capture audits to evaluate billing accuracy and identify revenue opportunities.
• Review medical records, documentation, coding, and billing practices to identify missing charges, coding discrepancies, and reimbursement risks.
• Perform root cause analyses on revenue leakage and develop corrective action plans.
• Ensure all billable services are appropriately captured to maximize reimbursement.
• Monitor compliance with CMS regulations, payer requirements, and industry billing standards.
• Identify and mitigate compliance risks associated with documentation and billing processes.
• Collaborate with clinical, coding, billing, and IT teams to improve workflows and documentation practices.
• Utilize Epic, audit tools, and analytics platforms to identify trends and process improvement opportunities.
• Review payer audit requests and technical denials.
• Determine appeal opportunities and prepare supporting appeal documentation.
• Track audit outcomes, denials, and appeal activity.
• Educate providers, clinicians, and operational teams on documentation and charge capture best practices.
• Build strong relationships with revenue cycle leadership and key stakeholders across the organization.
• Develop feedback mechanisms and continuous improvement initiatives informed by operational data.
• Maintain compliance with HIPAA regulations and organizational policies.

Required Qualifications

• 3–5 years of clinical healthcare experience.
• Strong understanding of medical terminology, patient care processes, and clinical documentation.
• Experience with medical billing, coding, revenue cycle operations, charge capture, or revenue integrity.
• Hands-on experience using Epic EMR.
• Knowledge of Medicare, Medicaid, managed care plans, commercial payers, and reimbursement methodologies.
• Understanding of healthcare regulations, compliance standards, and revenue cycle best practices.
• Strong analytical, problem-solving, and investigative skills.
• Excellent written and verbal communication abilities.
• Experience working within large health systems, academic medical centers, or multi-entity healthcare organizations preferred.
• Ability to effectively collaborate with physicians, clinical staff, leadership teams, and external stakeholders.

Preferred Qualifications

• Active New York State Registered Nurse (RN) License.
• Bachelor's Degree.
• Previous clinical auditing or revenue integrity experience.
• Professional coding or revenue cycle certification (CPC, CCS, CRC, RHIA, RHIT, or similar).
• Minimum 2 years of audit experience.
• Experience working in high-acuity healthcare environments.

Ideal Backgrounds

We are particularly interested in candidates with experience in:

• Clinical Revenue Integrity
• Revenue Cycle Management
• Charge Capture Auditing
• Clinical Documentation Review
• Medical Coding and Compliance
• Hospital-Based Revenue Operations
• Academic Medical Centers
• Large Health Systems