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Required Skills Education:

Associate's or Bachelor's degree in:
Health Information Management
Nursing
Healthcare Administration
Medical Coding
Criminal Justice
Public Health
Related healthcare field
Experience
2-5+ years reviewing medical records, claims, or healthcare documentation.

Experience in:

Fraud, Waste, and Abuse investigations
Medicare and Medicaid programs
Claims auditing
Utilization review
Clinical documentation review
SIU (Special Investigations Unit) operations
Knowledge Requirements
Medical terminology, anatomy, and physiology.
CPT, HCPCS, and ICD-10 coding systems.
Medicare, Medicaid, and commercial insurance regulations.
Healthcare compliance requirements (HIPAA, OIG guidelines, CMS regulations).
Documentation standards for healthcare providers.
Technical Skills
Electronic Medical Records (EMR/EHR) systems.
Claims processing systems.
Microsoft Office (Excel, Word, Outlook).
Data analysis and reporting tools.
Ability to identify documentation inconsistencies and billing irregularities.
Certifications (Often Preferred)
Certified Professional Coder (CPC)
Certified Coding Specialist (CCS)
Registered Health Information Technician (RHIT)
Registered Health Information Administrator (RHIA)
Certified Fraud Examiner (CFE)
Accredited Healthcare Fraud Investigator (AHFI)
Certified Professional Medical Auditor (CPMA)
Key Competencies
Strong analytical and critical-thinking skills.
Attention to detail.
Investigative mindset.
Ability to interpret complex medical documentation.
Report writing and case documentation skills.
Knowledge of healthcare fraud schemes and abuse indicators.

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Find & Apply For Claims Specialist / Adjuster / Examiner Jobs in Elkridge, Maryland

Fraud, Waste, and Abuse (FWA) Medical Record Reviewer