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Tria Federal (Tria) · 3 hours ago

Revenue Integrity Clinical Documentation & Coding Auditor (RN)

United States

Full-time

Remote

Senior Level

5+ years exp

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members, and civilians. They are seeking a Revenue Integrity Clinical Documentation & Coding Auditor (RN) to apply clinical nursing expertise to evaluate clinical documentation and medical coding while supporting revenue cycle functions within the Military Health System.

ConsultingInformation Technology

No H1B

U.S. Citizen Only

Responsibilities

Perform concurrent and retrospective reviews of clinical documentation and coded data for inpatient and outpatient encounters to support accurate coding and revenue integrity objectives

Validate alignment between provider documentation and assigned ICD-10-CM/PCS, CPT, and HCPCS codes, ensuring appropriate code selection, clinical specificity, and medical necessity

Assess documentation and coding impacts across revenue cycle workflows, including registration, charge capture, coding, billing, and claim readiness, as they relate to Revenue Integrity scope

Identify documentation, coding, and workflow issues that contribute to revenue leakage, claim edits, delayed billing, or downstream rework

Support Revenue Integrity initiatives focused on improving first-pass yield, reducing suspended charges and edits, and strengthening end-to-end revenue cycle performance

Collaborate with front-end, mid-cycle, and back-end revenue cycle stakeholders, including providers, coders, billing teams, and RI staff, to support issue resolution and sustainable improvements

Develop and deliver targeted education to revenue cycle stakeholders based on documentation and coding trends, root cause analysis, and regulatory best practices

Translate clinical and coding findings into clear, actionable summaries that describe operational, financial, and revenue cycle impacts

Support documentation and coding reviews associated with internal oversight, enterprise monitoring, and external review requests within RI scope

Monitor updates to coding guidelines, reimbursement rules, and regulatory requirements (e.g., CMS, TRICARE, DoD) and assess impacts to revenue integrity workflows

Contribute to standardization efforts, guidance development, and best practices that reinforce consistent documentation, coding, and revenue integrity processes across MTFs

Track and report revenue integrity–related metrics, including documentation and coding trends, root causes, education outcomes, and estimated revenue impact

Partner with RI leadership and operational teams to support enterprise visibility, risk identification, and continuous improvement across in-scope revenue cycle functions

Qualification

Registered Nurse (RN) licenseICD-10-CM/PCS codingCPT codingHCPCS codingDRGAPC methodologiesEHR system experienceRevenue Integrity programsAnalytical skillsPublic Trust clearanceCoding certificationsMilitary Health System experienceCommunication skillsCritical-thinking skills

Required

Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory

5+ years of clinical nursing experience, including 3+ years supporting documentation review, medical coding, revenue integrity, or coding quality initiatives

Strong working knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems and official coding guidelines

Solid understanding of DRG and APC payment methodologies, medical necessity standards, and how documentation and coding affect reimbursement

Familiarity with end-to-end revenue cycle workflows, particularly those within the scope of Revenue Integrity (registration, charge capture, coding, billing, and claim readiness)

Demonstrated experience working within or reviewing encounters in a major EHR system (e.g., Cerner, Epic)

Strong analytical and critical-thinking skills with the ability to connect clinical and coding findings to revenue cycle and financial outcomes

Excellent written and verbal communication skills, including the ability to provide constructive education and feedback to diverse revenue cycle stakeholders

Ability to obtain and maintain a Public Trust clearance