RN - Chart Review Job at MetroPlus Health Plan, New York, NY

bm1IRFZYSk5CNXZEbm1lZHM2VXM0Y0xlekE9PQ==
  • MetroPlus Health Plan
  • New York, NY

Job Description

Details

Client Name
Metroplus Health Plan

Job Type
Travel

Offering
Nursing

Profession
RN

Specialty
Case Manager

Job ID
34868793

Job Title
RN - Chart Review (000298)

Weekly Pay
$2369.33


Shift Details

Shift
Day - 7x5 - 10AM

Scheduled Hours
35


Job Order Details

Start Date
11/24/2025

End Date
01/17/2026

Duration
8 Week(s)


Job Description
Job Title: RN - Chart Review
Profession: Nursing
Specialty: Chart Review
Duration: 8 months
Shift: Hybrid
Hours per Shift: 35
Experience: 9-55 years of healthcare experience
License: Client RN License, Primary Source Verification
Certifications: AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) - Preferred


Must-Have:
Two years of experience


Description:
Utilize clinical knowledge to review medical charts for accuracy and sequencing of diagnoses.
Perform reviews on Consultation reports, History and Physical reports, Operative reports, Progress reports, and Discharge reports, including complex cases.
Use medical coding to review records and healthcare claims.
Determine the accuracy and compliance of billed codes with appropriate regulations, standards, policies, and procedures.
Conduct audits of high-risk claims and billing patterns to ensure adherence to regulations and policies.
Detect potential fraudulent activities such as over-utilization of services, upcoding, and billing for non-medically necessary services.
Collaborate with team members to evaluate suspected cases of fraud.
Create detailed reports with medical review findings, including research, rationale, sources, and corrective action recommendations.
Validate whether audited claims should be denied, recouped, or if other mitigation strategies are required.
Participate on provider calls to discuss findings and rationale of medical reviews.
Present findings to leadership and stakeholders to facilitate fraud proceedings.
Assist in preparing documentation for audits and compliance/legal reviews.
Maintain thorough documentation of investigations, including clinical findings, coding discrepancies, and communications.
Stay updated on changes to coding guidelines, regulations, and fraud detection methods to ensure effective investigations.
Complete special projects and audits as required.


Client Details

Address
50 Water Street

City
New York City

State
NY

Zip Code
10004


Job Board Disclaimer

By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe.
Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.

Job Tags

Weekly pay, Shift work,

Similar Jobs

Bridgestone Retail Operations

Entry-Level Automotive Maintenance Technician Growth & Training Job at Bridgestone Retail Operations

 ...A leading automotive service provider is seeking an Automotive Maintenance Technician in Blue Springs, MO. This entry-level role offers comprehensive training and the opportunity to work with a fantastic team on vehicle maintenance tasks. Ideal candidates will learn to... 

Only Data Entry

Remote Data Entry Specialist - Entry-Level Precision Job at Only Data Entry

 ...data solutions company is looking for a Junior Data Entry Specialist to join their team remotely. This entry-level position requires strong attention to detail and...  ...to follow instructions carefully and have basic computer skills. This position offers great opportunities... 

Dallas Independent School District

Literacy Media Specialist (Grades: 6-8) Job at Dallas Independent School District

 ...Join to apply for the Media Specialist (Grades: 6-8) role at Dallas Independent School...  ...students to develop skills in locating, evaluating, synthesizing, and using information to solve...  ..., TX $65,000.00-$70,000.00 2 days ago Social Media Manager- Conservative Media... 

Kinetic Personnel Group

Account Manager Job at Kinetic Personnel Group

Job Description Job Description Position Summary: KPG has partnered with a thriving manufacturer. They are seeking a full-time Account Manager, Sales Support Representative to join their dynamic team. This role will work closely with their high-demand field Sales Representatives... 

Soliant

Certified IV Compounding Pharmacy Technician in Murfreesboro, TN Job at Soliant

 ...Job Description Job Description Certified Pharmacy Technician (CPhT) certification and 1+ years Pharmacy Technician experience required...  ...Technician with specialized expertise in non-sterile compounding, seeking full-time employment in a compounding pharmacy setting...