Travel Nurse RN - Case Manager - $2,538 per week in New York City, NY
Company: Cynet Health
Location: New York City
Posted on: November 30, 2025
|
|
|
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.
Keywords: Cynet Health, New York , Travel Nurse RN - Case Manager - $2,538 per week in New York City, NY, Accounting, Auditing , New York City, New York
