Clinical Fraud & Compliance Coder (CPC/CPMA/CCS)

MetroPlus; New York (NY); Hybrid; USD 60,000 - 80,000; Full time

Job summary

MetroPlus is seeking a Clinical Coder to join its Special Investigations Unit in New York City. The candidate will review medical records and claims for compliance, conduct audits, and participate in investigations of suspected fraud.

A Bachelor's degree in Nursing and AAPC Coding certification are required, along with 5+ years of relevant experience. Strong analytical skills and attention to detail are essential for success in this role.

The position allows for hybrid work arrangements, promoting both collaboration and work-life balance.

Qualifications

• 5 years of experience in healthcare fraud detection, investigation, or auditing.
• In-depth experience and knowledge of coding regulations including ICD-10, CPT, and HCPCS.
• Valid New York State license as a Registered Professional Nurse.

Responsibilities

• Review medical records and healthcare claims for compliance.
• Conduct audits of high-risk claims to ensure adherence to regulations.
• Create detailed reports with findings and corrective actions.

Skills

Integrity and Trust

Customer Focus

Strong communication skills

Strong analytical skills

Attention to detail

Education

Bachelor’s degree in Nursing or related fields

AAPC Coding certification

Tools

Microsoft Office Suite

Job description

MetroPlus is seeking a Clinical Coder to join its Special Investigations Unit in New York City. The candidate will review medical records and claims for compliance, conduct audits, and participate in investigations of suspected fraud.

A Bachelor's degree in Nursing and AAPC Coding certification are required, along with 5+ years of relevant experience. Strong analytical skills and attention to detail are essential for success in this role.

The position allows for hybrid work arrangements, promoting both collaboration and work-life balance.