RN, Chart Reviewer

Job Title : RN, Chart Reviewer

Location : 50 Water Street, New York, NY 10004

Duration : 3+ Months contract

Education : BA in Nursing Required

Shift Details : Hybrid, M-F 9-5

Job Description :

• 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.
• 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.