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Travel Nurse RN - Case Manager - $2,598 per week in New York City, NY

TravelNurseSource

New York City, NY

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JOB DETAILS
SALARY
$2,597.50–$2,597.50
SKILLS
Auditing, Billing, Case Management, Certified Case Manager (CCM), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Clinical Outcomes, Code Reviews, Corrective Action, Documentation, Healthcare, Identify Issues, Leadership, Maintain Compliance, Medical Billing, Medical Coding, Patient Charts, Progress Reports, Registered Nurse (RN), Regulations, Regulatory Compliance, Reporting Skills, Risk
LOCATION
New York City, NY
POSTED
Today
TravelNurseSource is working with Cynet Health to find a qualified Case Manager RN in New York City, New York, 10004!

Job Title: RN - Chart Review Profession: Registered Nurse Specialty: Chart Review Duration: 8 weeks 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: Clinical knowledge to review medical charts Description: Utilize clinical knowledge to review medical charts for accuracy and sequencing of diagnoses. Review charts assigned from consultation reports, history and physical reports, operative reports, progress reports, and discharge reports. Assess complex cases as needed. Conduct medical coding reviews to determine the accuracy and compliance of billed codes with regulations, standards, policies, and procedures. Perform audits of high-risk claims and billing patterns to ensure adherence to healthcare 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 review findings that include research, rationale, sources, and corrective action recommendations. Validate whether audited claims should be denied, recouped, or if other mitigation strategies are required. Participate in provider calls to discuss findings and rationale of medical review as needed. Present findings to leadership and stakeholders to facilitate proceedings related to fraud. Assist in preparing documentation for audits, recoupments, compliance reviews, and regulatory inquiries. Maintain thorough documentation of investigations, including clinical findings and coding discrepancies. Stay updated on changes to coding guidelines, healthcare regulations, and fraud detection methods. Complete special projects and audits as required.

About the Company

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TravelNurseSource