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 medical record and claims review, ensuring compliance with guidelines while assessing potential overpayment, fraud, waste, and abuse. Proficient in conducting audits, providing training, and collaborating with healthcare professionals to enhance benefit integrity.
Highest-signal resume keywords
Medical Record ReviewClaims ReviewRN LicensureCoding CertificationFraud Assessment
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Data ReviewDesk ReviewsField AuditsData EntryReporting
Soft Skills
ConsultationTraining DevelopmentCommunication
Certifications & Qualifications
RN LicensureCoding Certification
Industry Keywords
MedicareMedicaidBenefit IntegrityFraudWasteAbuse
About the role
Key responsibilities & impact- Perform medical record and claims review for Medicare, Medicaid, and/or other claims data
- Ensure proper guidelines have been followed
- Assess potential overpayment, fraud, waste, and abuse
- Review beneficiary, provider, and/or pharmacy cases
- Complete desk reviews or field audits
- Consult with benefit integrity investigation experts and pharmacists
- Complete case summaries and provide results to investigators
- Perform case-specific or plan-specific data entry and reporting
- Participate in internal and external focus groups
- Participate in provider onsite visits and beneficiary interviews for field audits/investigations
- Testify at legal proceedings as necessary
- Provide job-specific orientation and training
- Help develop training content, resources, and programs
Requirements
What you’ll need- Minimum Bachelor's Degree required
- 2 - 4 years of experience required
- 5 - 7 years of experience preferred
- Medical review experience preferred
- Current, active and non-restricted RN licensure required
- Coding certification preferred
- Successful completion of pre-employment background and drug screens required
Benefits
Comp & perks- Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities
- Drug-free workplace
- Offers contingent upon successful completion of pre-employment background and drug screens