Job Description

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

PAY RANGE AND BENEFITS:

Pay Range*: $59 - $69 per hour *Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc. Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP). ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields. Recent Recognitions: Named One of America’s Best Employers for New Grads by Forbes (2024 Named One of the Best Companies to Work for by U.S. News & World Report (Private Companies List, 2024-2025) One of the Largest IT Staffing Firms in the US – Ranked #3 by Staffing Industry Analysts (SIA, 2024) One of the Largest Staffing Firms in the US – Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics) Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023) One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024) AWS Advanced Tier Services Partner with 100+ certifications Website: Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals. Submit referrals at and earn $250-$1,000 per referral. Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws. Innova

Job Tags

Hourly pay, Full time, Contract work, Temporary work, Work experience placement, Immediate start, Worldwide, Flexible hours, Shift work,

Similar Jobs