Clinical Documentation & Coding Auditor (RN)

Tria Federal is seeking a Clinical Documentation & Coding Auditor (RN) to support the Defense Health Agency’s (DHA) Revenue Integrity (RI) initiatives across the Military Health System (MHS). This role applies clinical nursing expertise to evaluate clinical documentation and medical coding while supporting all revenue cycle functions that fall within the scope of Revenue Integrity, including front-end, mid-cycle, and back-end processes that impact charge capture, coding accuracy, billing readiness, and reimbursement.

The role works collaboratively across revenue cycle stakeholders to identify documentation and coding issues, assess upstream and downstream revenue impacts, support revenue integrity initiatives, and promote standardized, compliant practices that reduce rework, prevent revenue leakage, and improve end-to-end revenue cycle performance.

**This opportunity is contingent upon award.**

Key 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.

Required Skills & Experience:

• 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.

Preferred Qualifications:

• Professional credentials such as CCDS, CDIP, CCS, CPC, or equivalent coding-focused certification.
• Experience supporting Revenue Integrity programs, enterprise coding quality efforts, or revenue cycle performance improvement initiatives.
• Familiarity with TRICARE and DoD billing and reimbursement requirements.
• Experience working in the Military Health System (MHS) or other federal healthcare environments.
• Hands-on experience with MHS GENESIS (Oracle Cerner) revenue cycle and clinical workflows.