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Rn Rac Auditor Jobs in Houston, TX (NOW HIRING)

Fresenius Medical Care

Registered Nurse

Houston, TX · On-site

... Nursing and/or Charge Registered Nurse, utilizing standard nursing techniques to assist the ... Complies with all data collection and auditing activities. * Maintains facility environmental ...

Gentiva

Afterhours RN Care Manager

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Current RN license in the state of employment * Graduate of an accredited nursing program * Minimum ...

Gentiva Hospice

Afterhours Care Manager RN

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Current RN license in the state of employment * Graduate of an accredited nursing program * Minimum ...

Gentiva Hospice

Afterhours Care Manager RN

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Current RN license in the state of employment * Graduate of an accredited nursing program * Minimum ...

Gentiva Hospice

Afterhours RN Care Manager

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Current RN license in the state of employment * Graduate of an accredited nursing program * Minimum ...

Gentiva Hospice

Afterhours RN Care Manager

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Current RN license in the state of employment * Graduate of an accredited nursing program * Minimum ...

Gentiva

Afterhours RN Care Manager

Stafford, TX · On-site

Clinical administrative responsibilities, workflow auditing, and survey readiness support are also ... Education and Experience * Current RN license in the state of employment * Graduate of an ...

Onco360

Quality Nurse - Oncology

Houston, TX · On-site

$80K/yr

Collaborate with the Director to develop auditing processes and training to ensure adherence to ... Licensed Registered Nurse (RN) * License must be in good standing in the state of practice

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How much do rn rac auditor jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for rn rac auditor in Houston, TX is $31.50, according to ZipRecruiter salary data. Most workers in this role earn between $27.55 and $34.42 per hour, depending on experience, location, and employer.

What is an RN RAC Auditor?

An RN RAC (Recovery Audit Contractor) Auditor is a registered nurse who reviews medical records to ensure compliance with Medicare and Medicaid billing regulations. They analyze documentation, identify improper payments, and help healthcare providers correct billing errors. Their role is crucial in preventing fraud, ensuring accurate reimbursement, and improving healthcare compliance.

What are the key skills and qualifications needed to thrive as an RN RAC Auditor?

To thrive as an RN RAC Auditor, you need a current RN license, strong clinical background, and in-depth knowledge of Medicare and healthcare reimbursement systems. Familiarity with tools such as electronic health records (EHRs), the Resident Assessment Instrument (RAI), and coding software like ICD-10 is crucial, and certification such as RAC-CT (Resident Assessment Coordinator-Certified) is often preferred. Attention to detail, analytical thinking, and strong written and verbal communication are valuable soft skills for auditing complex medical records and collaborating with interdisciplinary teams. These competencies ensure accurate compliance, optimal reimbursement, and the maintenance of high regulatory standards within healthcare organizations.

What are some common challenges faced by RN RAC Auditors in their daily work?

RN RAC Auditors often encounter challenges such as keeping up with frequently changing Medicare regulations, ensuring meticulous accuracy in clinical documentation, and coordinating with various healthcare professionals to resolve discrepancies. The role may require balancing multiple audits simultaneously and adapting quickly to new software or compliance standards. Successful RAC Auditors rely on strong organizational skills and up-to-date industry knowledge to navigate these challenges and support their facility’s compliance and reimbursement objectives. Most auditors work closely with MDS coordinators, billing departments, and clinical teams, making clear communication and teamwork essential. Staying proactive with ongoing education and training can also help ease these hurdles and contribute to long-term career growth.

What are popular job titles related to Rn Rac Auditor jobs in Houston, TX? For Rn Rac Auditor jobs in Houston, TX, the most frequently searched job titles are:
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Rn Rac Auditor jobs near you
Infographic showing various Rn Rac Auditor job openings in Houston, TX as of August 2026, with employment types broken down into 3% As Needed, 53% Full Time, 15% Part Time, and 29% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $65,527 per year, or $31.5 per hour.

Medical Compliance Auditor

Texas Children's Hospital

Bellaire, TX • On-site

Full-time

Re-posted 19 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 174 frontline employees who took The Breakroom Quiz

79th of 1,055 rated hospitals

Job description

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria.

Think you've got what it takes?

Job Duties & Responsibilities 
   Assess the treatment plan, clinical information, and medical necessity of all requested services 
   Utilizes established criteria to appropriately review billed services within established timeframe required. 
   Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. 
   Refers case failing medical necessity criteria to the Special Investigations Unit (SIU) Director and SIU Workgroup for review and a recommendation for action. 
   Telephonic follow-up with the provider's office to request additional information as needed. 
   Completes timely entry of information into electronic file including a chart with detailed findings of the review and a report summarizing the results of the audit. 
   Evaluate benefit coverage and regulatory guidelines pertinent to decision making for each investigation. 
   Perform Clinical and Coding Review on Medical Claim Appeals. 
   Assess and process all education and recoupment letters after Special Investigative Committee review decision. 
   Facilitates provider communication and education. 
   Liaisons with internal staff members. 
   Perform Clinical Review and make recommendation on Audit Pass/Fail. 
   Ongoing assessment for quality indicators and concerns.


Skills & Requirements 
    Required Associate's Degree in Nursing  or
    Technical Diploma in Vocation Nursing
    Preferred Bachelor's Degree in Nursing
    Required LVN - Lic- Licensed Vocational Nurses Texas Board of Nursing or Nursing Licensure Compact or 
    RN-Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact 
    Preferred CPC-Cert-Cert Professional Coder Americal Academy of Professional Coders
     Required 3 years Clinical experience in the applicable field according to the license (LVN or RN) 
     4 years of Medical Auditing experience.
 

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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