Job Description

Job Description

PRIDE Health is seeking a travel nurse RN Clinical Document Improvement Specialist for a travel nursing job in New YOrk, New York.

• Specialty: Clinical Document Improvement Specialist
• Discipline: RN
• Start Date: ASAP
• Duration: 13 weeks
• 40 hours per week
• Shift: 8 hours, days
• Employment Type: Travel

Position: Chart Review (Special Investigations Unit Clinical )

** Hybrid Position **

Shift: 9am - 5pm 

Requirements: 

5 years of healthcare fraud detection, investigation, or auditing, & In-depth experience and knowledge of coding regulations including ICD-10, CPT, HCPCS, AMA, etc.

Job Description 

• Review medical records to validate clinical and coding assessments, as well as medical coding, and review healthcare claims to determine the accuracy and compliance of billed codes with relevant regulations, standards, policies, and procedures.
• Conduct audits of high-risk claims and billing patterns to ensure adherence to healthcare regulations and MetroPlusHealth policy, and detect potential FW.A
• Assist in preparing documentation for audits, recoupments, compliance/legal reviews, and regulatory inquiries.
• 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. 

PRIDE Health is the minority-owned healthcare recruitment division of Pride Global—an integrated human capital solutions and advisory firm. With our robust and abundant travel nursing and allied health employment options across the U.S., PRIDE Health will allow you to help change the way the world lives and heals as it connects you with the industry’s leading healthcare organizations.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

• Weekly pay
• Holiday Pay
• Guaranteed Hours
• 401k retirement plan
• Cancelation protection
• Referral bonus
• Medical benefits
• Dental benefits
• Vision benefits

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