ProKatchers

Job Title : RN Clinical Coder Location : New York, NY 10004 Duration : 3+ Months / 13 Weeks Education : Bachelor's in Nursing (BA/BSN) required Shift Details : 9:00 AM - 5:00 PM / Hybrid - Onsite & Remote Specific Skills : Review medical charts for accuracy, completeness, and proper diagnosis sequencing. Validate clinical and coding assessments in alignment with regulations. Conduct audits of high-risk claims and billing patterns to identify discrepancies and potential FWA. Prepare detailed clinical review reports, including rationale, research, and corrective action recommendations. Assist with documentation for audits, compliance reviews, recoupments, and regulatory inquiries. Active New York State RN License (Primary Source Verified) Minimum 2 years of clinical experience 5+ years of Healthcare Experience required

Job Title : Financial Compliance Auditor III Location : Los Angeles, CA 90017(Remote) Duration : 21 weeks Job Description: The Specialty Health Plans Auditor III, Finance is responsible all aspects of planning, execution, reporting, and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental, behavioral health, transportation, and telehealth services providers. Essential Duties and Responsibilities: Performs financial audits and/or financial analyses for Specialty Health Plans on the quarterly and annual basis. Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors. Experience Required: At least 4 years of experience in conducting financial audits. At least 5 years of...