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


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Job Tags

Weekly pay, Shift work,

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