Job Description

JOB TITLE: Clinical Revenue Integrity Auditor, Surgical Services

SUPERSEDES: *NEW*

FLSA: Exempt

JOB CODE: 6607

ISSUED: 09/2025

REVISED: *NEW*

BASIC FUNCTION AND RESPONSIBILITY

The Clinical Revenue Integrity Auditor, Surgical Services conducts pre- and post-payment audits of surgical medical records and associated documentation to ensure accurate charge capture, billing compliance, and revenue integrity. Serves as a subject matter expert in surgical billing practices, collaborating with Revenue Cycle Services and other departments to resolve clinical charge-related issues and denials. Oversees charge entry accuracy, supply and implant tracking, and system integration between clinical, billing, and inventory management platforms.

ESSENTIAL FUNCTIONS

Audits surgical inpatient and outpatient medical records against billing records to validate charge capture and make appropriate adjustments to the financial account.

Reviews inventory in the TrackCore system to ensure accurate documentation and tracking of organic tissues and surgical supplies.

Identifies and submits requests to build new surgical supplies and implants into Cerner, PeopleSoft, and the chargemaster.

Investigates and resolves interface issues between SurgiNet and TrackCore that impact charge accuracy and tissue tracking.

Applies and resolves hold bills related to documentation discrepancies and missing charges.

Researches charge and documentation issues reported by Revenue Cycle Services, coding teams, or third-party audit tools, and provides clinical resolution.

Performs charge validations for pre-pay reviews and supports the resolution of billing inquiries from Hospital Patient Accounts and other stakeholders.

Reviews Cerner SurgiNet reports to identify and track cases with documentation errors, missing finalization, or incomplete charge capture.

Performs trending and monitoring activities to identify charge capture gaps and recommend process improvements or education opportunities.

Collaborates with coders, nurses, surgical technologists, and supply chain staff to ensure compliance with billing guidelines and accurate record documentation.

Supports compliance with third-party payer requirements, internal charge protocols, and vendor agreements related to implant and supply billing.

Participates in special projects and initiatives related to surgical services,

charge capture, and revenue cycle integrity.

May complete unit/department-specific duties as outlined in department documents.

KNOWLEDGE, SKILLS AND ABILITIES

Demonstrates detailed knowledge of surgical billing practices, documentation standards, charge capture, and medical coding principles.

Applies strong analytical and clinical knowledge to identify charge discrepancies, interpret documentation, and correct financial records.

Communicates effectively with clinical and administrative teams to resolve billing issues and implement compliant charge practices.

Utilizes electronic health records, inventory systems, and charge auditing tools to support revenue integrity.

Maintains up-to-date knowledge of reimbursement guidelines, surgical documentation requirements, and inventory management systems.

SUPERVISION RECEIVED

Supervision is received from a designated leader in the Surgical Services department.

SUPERVISION EXERCISED

Functional supervision may be exercised over surgical services staff.

REQUIRED QUALIFICATIONS

Bachelor's degree in nursing, hospital administration, business, finance, or an equivalent combination of education and experience from which comparable knowledge, skills and abilities can be acquired.

Five (5) years of related healthcare experience.

PREFERRED QUALIFICATIONS

Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H) by the American Academy of Professional Coders (AAPC).

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) by the American Health Information Management Association (AHIMA).

Clinical experience in the operating room or surgical services setting.

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.

SAFETY SENSITIVE STATUS

This position is considered safety sensitive.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.