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Insurance Chart Review Jobs (NOW HIRING)

LabMinds Staffing & Recruiting

Minimum 8 years of clinical nursing experience, with at least 3 years in chart review, risk ... Understanding of medical necessity criteria, level of care reviews, public/private insurance ...

AltaPointe Health

Care Manager

AL · On-site

Chart Review and Documentation * Conduct structured reviews of clinical records to assess service ... Resolve barriers such as transportation, insurance, or documentation needs. * Risk Identification ...

AltaPointe Health

Care Manager

Mobile, AL

Chart Review and Documentation * Conduct structured reviews of clinical records to assess service ... Resolve barriers such as transportation, insurance, or documentation needs. * Risk Identification ...

AltaPointe Health

Care Manager

Mobile, AL · On-site

Chart Review and Documentation * Conduct structured reviews of clinical records to assess service ... Resolve barriers such as transportation, insurance, or documentation needs. * Risk Identification ...

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Insurance Chart Review information

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$28K

$62.3K

$105K

How much do insurance chart review jobs pay per year?

As of Aug 10, 2026, the average yearly pay for insurance chart review in the United States is $62,283.00, according to ZipRecruiter salary data. Most workers in this role earn between $44,000.00 and $83,500.00 per year, depending on experience, location, and employer.

What are some common challenges faced by professionals in insurance chart review?

Professionals in Insurance Chart Review often encounter the challenge of keeping up with constantly changing insurance policies, coding guidelines, and healthcare regulations. Maintaining accuracy while reviewing large volumes of charts and navigating incomplete or unclear documentation can also be demanding. Additionally, balancing productivity targets with the need for thoroughness requires strong organizational skills. Successfully addressing these challenges is vital to ensuring accurate claims processing and supporting positive patient outcomes.

What is an insurance chart review?

An Insurance Chart Review job involves reviewing medical records and documentation to ensure accuracy, compliance, and proper coding for insurance claims. Professionals in this role assess patient charts to verify that services billed are medically necessary and supported by records. They may work for insurance companies, healthcare providers, or third-party auditors to minimize errors and prevent fraud. Strong attention to detail and knowledge of medical terminology, billing codes, and insurance guidelines are essential for success in this role.

What are the key skills and qualifications needed to thrive in insurance chart review?

To excel in Insurance Chart Review, you need a strong understanding of medical terminology, coding practices, and healthcare documentation, often supported by certifications such as CPC, CCS, or RHIT. Familiarity with electronic health records (EHRs), coding software, and insurance company systems is typically required. Attention to detail, analytical thinking, and effective written communication are standout soft skills for this role. These competencies ensure accurate, compliant reviews that support insurance claims processing and minimize errors.

More about Insurance Chart Review jobs
What cities are hiring for Insurance Chart Review jobs? Cities with the most Insurance Chart Review job openings:
What are the most commonly searched types of Insurance Chart Review jobs? The most popular types of Insurance Chart Review jobs are:
What states have the most Insurance Chart Review jobs? States with the most job openings for Insurance Chart Review jobs include:
What job categories do people searching Insurance Chart Review jobs look for? The top searched job categories for Insurance Chart Review jobs are:
Insurance Chart Review jobs near you
Infographic showing various Insurance Chart Review job openings in the United States as of August 2026, with employment types broken down into 84% Full Time, and 16% Part Time. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $62,283 per year, or $29.9 per hour.

Clinical RN Chart Reviewer, (Remote) CIC or CCS certified

ProgenyHealth LLC

Plymouth Meeting, PA • On-site

$90K - $110K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 3 days ago

Job description

Description:

Job Role


The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Senior Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines.

Requirements:

Responsibilities will include:

  • Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
  • Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
  • Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
  • Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
  • Utilize Clinical Review Tools and EMR Systems.
  • Research reimbursement regulations for claim payment compliance to support and validate audit findings.
  • Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.
  • Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement.


Qualifications:

  • Registered Nurse required, preferable NICU
  • 2+ years with inpatient claims, required, preferably NICU and maternity
  • Inpatient Coding Certification required - CCS or CIC. If not currently certified, requirement to obtain CIC or CCS within 6 months of hire, applicant responsible for exam and associated fees*
  • Experience in nursing, inpatient coding and reimbursement guidelines, and specifically, has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.
  • 2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
  • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
  • Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
  • Experience with appeals is strongly preferred.
  • Excellent communication skills, both oral and written.
  • Strong interpersonal skills that will support collaborative teamwork.
  • Proficient in Microsoft Office: Word and Excel; Access – highly preferred.
  • Ability to work independently and within a team.
  • Critical listening, thinking, decision making and problem solving.


Benefits


This position has a salary range of $90,000 - $110,000 annually based on relevant experience. Some of the benefits we offer our team are:

  • Paid Time Off
  • Paid Parental Leave
  • Medical, dental, vision benefits
  • 401K with company match
  • Short- and Long-Term Disability
  • Group Life Insurance
  • Tuition reimbursement
  • Professional development opportunities
  • Business Casual work environment
ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com


Equal Opportunity Employer, including individuals with disabilities and veterans.