Demonstrates expertise in reviewing and analyzing medical records and claims data for accuracy and compliance with HIPAA and CMS regulations. Strong analytical skills are essential for identifying inconsistencies and supporting internal audits and quality assurance initiatives.

Highest-signal resume keywords

Medical Records ReviewClaims Data AnalysisHIPAA ComplianceStrong Analytical SkillsMicrosoft Excel

About the role

Key responsibilities & impact

Review and analyze medical records and claims data for accuracy, completeness, and regulatory compliance
Verify clinical documentation supporting claim submissions and medical necessity
Identify and resolve inconsistencies, errors, or missing documentation
Prioritize workloads so expedited and high-priority cases meet defined timelines
Collaborate with healthcare providers, coders, and billing staff
Ensure compliance with HIPAA, CMS, and other medical-record and claims-processing regulations
Prepare reports and summaries of claim findings, trends, and process improvements
Support internal audits and quality assurance initiatives
Complete audits promptly and meet quality and production targets
Follow SOPs, project protocols, and applicable regulations
Report issues and trends, maintain productivity and clarification logs, and respond to manager emails
Seek clarification from managers or team leaders when needed

Requirements

What you’ll need

Any Graduate/ Postgraduate
3-5 years of experience
Good communication, flexibility, and reliability
Knowledge of Microsoft Outlook, Excel, Word, and PowerPoint
Strong analytical skills with the ability to investigate and resolve issues
Familiarity with HIPAA, Medicare, Medicaid, and other payer-specific regulations
Working hours: 40 hours/week
Full-time employee

Benefits

Comp & perks

High-speed internet connection and power backup required for telecommuting
Hybrid work model after 2 months of office training

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingRegulatory ComplianceDocumentation VerificationData AnalysisAudit Completion

Soft Skills

Good CommunicationFlexibilityReliability

Tools & Technologies

Microsoft OutlookMicrosoft ExcelMicrosoft WordMicrosoft PowerPoint

Industry Keywords

MedicareMedicaidPayer-Specific RegulationsQuality AssuranceSOPs