What are the responsibilities and job description for the Clinical certified Coder position at MetroPlusHealth?
Job Description – SIU Clinical Certified Coder / RN Chart Reviewer
Job Title: SIU Clinical Certified Coder
Department: Clinical Services Admin
Schedule: Hybrid, Mon–Fri, 9 AM–5 PM (35 hrs/week)
Location: New York, NY
Overview
MetroPlusHealth seeks an experienced RN Clinical Coder to support the Special Investigations Unit (SIU) in detecting, preventing, and investigating healthcare Fraud, Waste, and Abuse (FWA). The role involves clinical chart review, coding validation, and audit support.
Key Responsibilities
Review medical records and claims for coding accuracy (ICD-10, CPT, HCPCS) and regulatory compliance.
Conduct audits on high-risk claims and identify potential FWA issues.
Prepare detailed reports with clinical and coding findings, rationale, and recommendations.
Participate in provider calls, meetings, and presentations of findings.
Support documentation for audits, recoupments, legal/compliance reviews, and regulatory inquiries.
Maintain thorough investigation documentation and stay updated on coding and regulatory changes.
Required Qualifications
RN – New York State License (Required)
AAPC/AHIMA certification (CPC, CPMA, CCS)
Bachelor’s degree in Nursing or related field
5 years’ experience in medical auditing, coding, or FWA investigation
Strong knowledge of ICD-10, CPT, HCPCS
Strong communication, analytical, and documentation skills
Experience with Medicaid/Medicare preferred
Job Types: Contract, Temporary
Pay: $58.00 - $60.00 per hour
Expected hours: 35 per week
Benefits:
- Referral program
Application Question(s):
- Willing to work Hybrid 9-5 schedule
- Bachelor’s degree in Nursing, Medical Billing/Medical Coding, Healthcare or other related fields
Education:
- Bachelor's (Preferred)
Experience:
- Special Investigations Unit Clinical Certified Coder: 5 years (Preferred)
- healthcare fraud detection, investigation, or auditing: 5 years (Preferred)
Ability to Commute:
- New York, NY 10004 (Preferred)
Work Location: In person
Salary : $58 - $60