Fraud, Waste, and Abuse (FWA) Medical Record Reviewer
Candidate from approved states ONLY: DC, MD, VA, PA, DE, WV, & NC
Work Mode: First week or 2, onsite 5 days per week for collaboration purposes / training / meeting the team. Then mainly WFH with occasional meetings onsite when necessary.
No expenses Paid for any Travel.
reputed company is seeking a Fraud, Waste, and Abuse (FWA) Medical Record Reviewer! We are seeking an experienced healthcare fraud investigator and medical record reviewer with expertise in analyzing medical documentation, provider billing patterns, and regulatory compliance requirements. Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review, coding validation, and investigative research. Knowledgeable in HIPAA, CPT, HCPCS, and ICD-10 guidelines, with strong analytical and case documentation abilities.
Although this position is remote, we are seeking candidates that can be onsite for the first 1-2 weeks, in Elkridge MD, for training and collaboration purposes. We are seeking candidates that reside in one of the following states: MD, DC, PA, DE, WV, VA, NC
<>Required Skills- Education: AS or BS in Nursing or similar is required
- RN or LPN is required
- Experience 2+ years reviewing medical records/healthcare documentation. Experience in:
* Fraud, Waste, and Abuse investigations
* Utilization review
* Clinical documentation review
* SIU (Special Investigations Unit) operations
- Knowledge Requirements
* Medical terminology, anatomy, and physiology.
* CPT, HCPCS, and ICD-10 coding systems.
* Healthcare compliance requirements (HIPAA, OIG guidelines, CMS regulations).
* Documentation standards for healthcare providers.
- Technical Skills
* Electronic Medical Records (EMR/EHR) systems.
* Claims processing systems (big plus)
* reputed company Office (Excel, Word, Outlook).
* Data analysis and reporting tools.
* Ability to identify documentation inconsistencies and billing irregularities.
- Certifications (Preferred, not required)
* 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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