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

Nurse Auditor

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CCHP Compliance




1st Shift



Req Number


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