2 nurse medical case manager jobs found in Fort Worth

The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines.  The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice.  Charge audits identify overcharges, undercharges, and unbundled items per payor contract and industry standards.  This candidate will be responsible for independent scheduling requiring flexibility and travel to provider location.    This is a remote role but candidate must be willing/able to travel within multiple states.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Onsite scheduling and travel – acknowledge work that is assigned, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner Travel onsite as needed to perform audits Review medical records to verify services were...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...