RN - Chart Review

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

$2538.42

Shift Details

Shift

Day - 7.5x5 - 09AM

Scheduled Hours

37

Job Order Details

Start Date

12 / 15 / 2025

End Date

02 / 07 / 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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