FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing medical claims for accuracy and compliance with CMS guidelines and payer policies, while effectively collaborating with multidisciplinary teams to enhance documentation and coding practices.
Highest-signal resume keywords
Bachelor's Degree In NursingActive State Nursing CertificationClinical/Hospital ExperienceMedical Terminology FamiliarityStrong Written And Oral Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims ReviewAudit ReportingDocumentation AccuracyCoding Inaccuracy IdentificationCompliance MonitoringBest-Practice AuditsRevenue Leakage IdentificationDiagnosis ValidationProcedure ValidationLevel Of Care Validation
Soft Skills
Effective Team ParticipationPrompt CommunicationProcess Improvement Mindset
Certifications & Qualifications
Active State Nursing Certification
Industry Keywords
CMS GuidelinesPayer PoliciesUS Healthcare SystemCare Management ConceptsSOPsProject ProtocolsQuality Assurance Initiatives
About the role
Key responsibilities & impact- Review and audit medical claims against patient medical records for documentation accuracy and completeness
- Identify discrepancies between clinical documentation and billed services, including potential billing errors
- Validate diagnoses, procedures, and level of care against industry standards
- Ensure compliance with CMS guidelines, payer policies, and regulatory requirements
- Conduct best-practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities
- Prepare structured audit reports with recommendations for corrective action and process improvement
- Collaborate with coding, billing, and provider teams to resolve audit findings
- Monitor audit trends and recurring issues requiring education or intervention
- Support quality assurance initiatives and maintain audit accuracy and productivity standards
- Maintain daily productivity and clarification logs, respond promptly to emails, and align with managers/team leads on program delivery
Requirements
What you’ll need- Bachelor’s degree in nursing
- Active State Nursing certification is Mandatory
- Minimum 3 years of clinical/hospital experience is mandatory
- Strong written (documentation) and oral communication skills
- Familiarity with basic medical terminology and care management concepts
- Good understanding of the US healthcare system and management
- Ability to participate effectively in a multidisciplinary team
- Must understand and adhere to the telecommuter policy
- Must follow SOPs, project protocols, and instructions
- Must achieve expected quality and production targets
- Must work 08:00 AM to 05:00 PM IST, subject to project requirements
Benefits
Comp & perks- Full-time schedule of 40 hours per week
- Weekends off
- Hybrid work arrangement
- High-speed broadband internet connection at home
- Opportunity to participate in continuous improvement activities and process training