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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing medical claims against patient records, ensuring compliance with CMS guidelines and payer policies. Proficient in identifying discrepancies and preparing structured audit reports to support process improvement and quality assurance initiatives.
Highest-signal resume keywords
Bachelor's Degree In NursingActive State Nursing CertificationClinical/Hospital ExperienceMedical Terminology FamiliarityUS Healthcare System Understanding
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 ValidationCoding Accuracy AssessmentCompliance Monitoring
Soft Skills
Strong Written CommunicationOral Communication SkillsTeam CollaborationAttention To DetailProblem-Solving
Certifications & Qualifications
Active State Nursing Certification
Industry Keywords
CMS GuidelinesPayer PoliciesClinical DocumentationRevenue LeakageQuality Assurance
About the role
Key responsibilities & impact- Review and audit medical claims against patient medical records for accurate and complete documentation
- 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 and support accurate claim submissions
- Monitor audit-result trends and identify recurring issues requiring education or intervention
- Support quality assurance initiatives and maintain audit accuracy and productivity standards
- Review medical records using clinical knowledge and make clear, precise determinations
- Complete audits with quality, update productivity and clarification logs, and meet production targets
- Maintain process knowledge, follow SOPs, respond 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 concepts used in care management
- Good understanding of US healthcare system and management
- Ability to participate effectively in a multi-disciplinary team
- Must understand and adhere to telecommuter policy
- Must follow SOPs, project-related protocols, and instructions
- Must achieve expected quality and production targets
- Shift time: 08:00 AM to 05:00 PM IST, subject to change based on project requirements
Benefits
Comp & perks- Full-time schedule of 40 hours per week
- Weekends off
- High-speed broadband internet requirement for telecommuting
- Hybrid work arrangement
- Opportunity to participate in continuous improvement activities and process training