Cook Children's Healthcare Nurse Auditor in Fort Worth, Texas

Nurse Auditor

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Department

CCHP Compliance

Schedule

Full-Time

Shift

1st Shift

Hours

M-F

Req Number

37398

Job Details

This role is primarily responsible for reviewing clinical documentation in relation to investigations of possible fraud, waste or abuse. Verify correct billing and/or coding of ICD-9 and CPT codes of health plan claims according to medical record documentation. Identification of medical record support for global/bundled codes. Review medical records for potentially preventable readmissions and potentially preventable complications. Review certain APR-DRGs when the billed DRG is an outlier. Provide feedback to the Compliance Director of findings of medical record reviews. QUALIFICATIONS: At least 5 years of experience to include time as a care giver as well as an auditor Recent experience in the area of auditing records to ascertain appropriate level of documentation and compliance with billing and/or legal requirements Previous medical record or billing audit experience preferred Licensure, Registration, and/or Certification: The individual in this position must be Registered Nurse Certified Professional Coder certification preferred

EOE/AA, M/F/Disability/Vet