A client of Innova Solutions is immediately hiring for a RN - Chart Review Position type: Contract/ Full time Duration: 6-month Location: 50 Water Street, FL 7, New York City New York 10004 United States Shift: Hybrid 9-5 As a RN - Chart Review, you will: Review medical records and healthcare claims to 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 healthcare regulation and policy and detect potential FWA. Collaborate with other SIU team members to evaluate suspected cases of fraudulent activities, such as over-utilization of services, upcoding, and billing for non-medically necessary services. Create detailed reports with medical review findings that include research, rationale, sources and corrective action recommendations to the SIU Department. The reports will also validate whether audited claims should be denied, recouped and if other mitigation strategies are required. Participate as needed on provider calls to discuss findings and rationale of medical review. Present findings to leadership and other stakeholders to facilitate all FWA proceedings. Assist in preparing documentation for audits, recoupments, compliance/legal reviews and regulatory inquiries. Maintain thorough documentation of investigations, including clinical findings, coding discrepancies and all communication with healthcare providers and investigators. Stay updated to changes to coding guidelines, healthcare regulations, and fraud detection methods to ensure compliance and effective investigations. Completes special projects and audits as required. The ideal candidate will have: AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) - Required Registered Nurse (RN) – Required 5 years of experience in healthcare fraud detection, investigation, or auditing In depth experience and knowledge of coding regulations including ICD-10, CPT, HCPCS, AMA etc. AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) Bachelor’s degree in Nursing, Medical Billing/Medical Coding, Healthcare or other related fields Strong communication skills to interact with providers, medical management, legal teams, and compliance departments. Strong analytical, research and problem-solving aptitude with attention to detail and accuracy Preferred candidate will have experience in Medicaid, Medicare, and Marketplace/Exchange Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible. We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW. Thank you! Jyoti Tiwari 678-496-7813 Jyoti.Tiwari2@innovasolutions.com
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