Know ATS Score
CV/Résumé Score
  • Expertini Resume Scoring: Our Semantic Matching Algorithm evaluates your CV/Résumé before you apply for this job role: Nurse Clinician Managed Care (Certified Coder).
United States Jobs Expertini

Urgent! Nurse Clinician Managed Care (Certified Coder) Job Opening In New York County New York – Now Hiring Integrated Resources, Inc

Nurse Clinician Managed Care (Certified Coder)



Job description

Job Title: Nurse Clinician Managed Care (Certified Coder)

Location: New York, NY 10004

Duration: 3+ months with very high possibility of extension



Shift Time: Monday – Friday, 9:00 AM – 5:00 PM (Hybrid)

 

Department: Special Investigations Unit (SIU)



Pay range: $50 - $55/hr.

on W2


 

Remarks:

This is a hybrid position; candidates must have a valid New York State RN license.

Primary Source License Verification is required.

The successful candidate will support medical coding integrity and contribute to protecting the organization and its members from fraud and abuse.

 

Position Overview:


  • We are committed to empowering New Yorkers by uniting communities through care.

    At our core, we believe healthcare is a right, not a privilege.

    If you are a compassionate professional with a collaborative spirit, join us and take pride in the work you do every day.

  • We are currently seeking a Clinical Certified Coder to join our Special Investigations Unit (SIU).

    The coder will play a key role in detecting, preventing, and investigating suspected fraud, waste, and abuse (FWA) within healthcare billing and clinical documentation.


 

Key Responsibilities:


  • Review medical records and healthcare claims to ensure clinical and coding accuracy and compliance with applicable standards and regulations.

  • Conduct audits of high-risk claims and billing patterns to identify discrepancies, over-utilization, upcoding, and medically unnecessary services.

  • Collaborate with SIU investigators and analysts to evaluate potential fraud or abuse cases.

  • Create detailed medical review reports including clinical findings, supporting rationale, regulatory sources, and recommended actions.

  • Determine whether claims should be denied or recouped and suggest appropriate mitigation strategies.

  • Participate in provider calls and internal meetings to present audit findings and provide clinical/coding insights.

  • Support documentation needs for audits, legal/compliance reviews, and regulatory responses.

  • Maintain accurate records of investigations, including clinical notes, coding discrepancies, and communications.

  • Stay up to date with changes in coding guidelines (ICD-10, CPT, HCPCS, etc.), fraud detection practices, and federal/state healthcare regulations.

  • Complete special projects and audits as assigned by leadership.


 

Required Experience:


  • Minimum 5 years of experience in healthcare fraud detection, auditing, or medical record review

  • Strong clinical background with knowledge of medical terminology, billing practices, and healthcare regulations

  • Proficient in coding standards: ICD-10, CPT, HCPCS, and AMA guidelines

  • Strong analytical, research, and critical-thinking skills

  • Excellent written and oral communication skills; able to communicate complex clinical findings clearly

  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)

  • Experience in Medicaid, Medicare, and/or Marketplace/Exchange plans – preferred


 

Required Qualifications:


  • Registered Nurse (RN) – Must have active New York State license

  • AAPC Certification – One or more of the following required:

  • Certified Professional Coder (CPC)

  • Certified Professional Medical Auditor (CPMA)

  • Certified Coding Specialist (CCS)




  • Bachelor’s Degree in Nursing, Medical Coding/Billing, Healthcare Administration, or related field




 


Required Skill Profession

Other General



Your Complete Job Search Toolkit

✨ Smart • Intelligent • Private • Secure

Start Using Our Tools

Join thousands of professionals who've advanced their careers with our platform

Rate or Report This Job
If you feel this job is inaccurate or spam kindly report to us using below form.
Please Note: This is NOT a job application form.


    Unlock Your Nurse Clinician Potential: Insight & Career Growth Guide


  • Real-time Nurse Clinician Jobs Trends in New York County, New York, United States (Graphical Representation)

    Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Nurse Clinician in New York County, New York, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 206443 jobs in United States and 6860 jobs in New York County, New York. This comprehensive analysis highlights market share and opportunities for professionals in Nurse Clinician roles. These dynamic trends provide a better understanding of the job market landscape in these regions.

  • Are You Looking for Nurse Clinician Managed Care (Certified Coder) Job?

    Great news! is currently hiring and seeking a Nurse Clinician Managed Care (Certified Coder) to join their team. Feel free to download the job details.

    Wait no longer! Are you also interested in exploring similar jobs? Search now: .

  • The Work Culture

    An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at Integrated Resources, Inc adheres to the cultural norms as outlined by Expertini.

    The fundamental ethical values are:
    • 1. Independence
    • 2. Loyalty
    • 3. Impartiality
    • 4. Integrity
    • 5. Accountability
    • 6. Respect for human rights
    • 7. Obeying United States laws and regulations
  • What Is the Average Salary Range for Nurse Clinician Managed Care (Certified Coder) Positions?

    The average salary range for a varies, but the pay scale is rated "Standard" in New York County New York. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.

  • What Are the Key Qualifications for Nurse Clinician Managed Care (Certified Coder)?

    Key qualifications for Nurse Clinician Managed Care (Certified Coder) typically include Other General and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.

  • How Can I Improve My Chances of Getting Hired for Nurse Clinician Managed Care (Certified Coder)?

    To improve your chances of getting hired for Nurse Clinician Managed Care (Certified Coder), consider enhancing your skills. Check your CV/Résumé Score with our free Tool. We have an in-built Resume Scoring tool that gives you the matching score for each job based on your CV/Résumé once it is uploaded. This can help you align your CV/Résumé according to the job requirements and enhance your skills if needed.

  • Interview Tips for Nurse Clinician Managed Care (Certified Coder) Job Success
    Integrated Resources, Inc interview tips for Nurse Clinician Managed Care (Certified Coder)

    Here are some tips to help you prepare for and ace your job interview:

    Before the Interview:
    • Research: Learn about the Integrated Resources, Inc's mission, values, products, and the specific job requirements and get further information about
    • Other Openings
    • Practice: Prepare answers to common interview questions and rehearse using the STAR method (Situation, Task, Action, Result) to showcase your skills and experiences.
    • Dress Professionally: Choose attire appropriate for the company culture.
    • Prepare Questions: Show your interest by having thoughtful questions for the interviewer.
    • Plan Your Commute: Allow ample time to arrive on time and avoid feeling rushed.
    During the Interview:
    • Be Punctual: Arrive on time to demonstrate professionalism and respect.
    • Make a Great First Impression: Greet the interviewer with a handshake, smile, and eye contact.
    • Confidence and Enthusiasm: Project a positive attitude and show your genuine interest in the opportunity.
    • Answer Thoughtfully: Listen carefully, take a moment to formulate clear and concise responses. Highlight relevant skills and experiences using the STAR method.
    • Ask Prepared Questions: Demonstrate curiosity and engagement with the role and company.
    • Follow Up: Send a thank-you email to the interviewer within 24 hours.
    Additional Tips:
    • Be Yourself: Let your personality shine through while maintaining professionalism.
    • Be Honest: Don't exaggerate your skills or experience.
    • Be Positive: Focus on your strengths and accomplishments.
    • Body Language: Maintain good posture, avoid fidgeting, and make eye contact.
    • Turn Off Phone: Avoid distractions during the interview.
    Final Thought:

    To prepare for your Nurse Clinician Managed Care (Certified Coder) interview at Integrated Resources, Inc, research the company, understand the job requirements, and practice common interview questions.

    Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the Integrated Resources, Inc's products or services and be prepared to discuss how you can contribute to their success.

    By following these tips, you can increase your chances of making a positive impression and landing the job!

  • How to Set Up Job Alerts for Nurse Clinician Managed Care (Certified Coder) Positions

    Setting up job alerts for Nurse Clinician Managed Care (Certified Coder) is easy with United States Jobs Expertini. Simply visit our job alerts page here, enter your preferred job title and location, and choose how often you want to receive notifications. You'll get the latest job openings sent directly to your email for FREE!