Clinical Medical FWA Analyst

Location: Remote for candidates residing in MD, DC, PA, DE, WV, VA, or NC; onsite training and collaboration required for the first 1–2 weeks in Elkridge, Maryland.

Company

hirify.global is hiring for a healthcare fraud, waste, and abuse analysis role focused on medical record review and compliance investigation.

What you will do

• Review medical records and healthcare documentation for potential fraud, waste, and abuse indicators.
• Analyze provider billing patterns and identify documentation inconsistencies and billing irregularities.
• Validate CPT, HCPCS, and ICD-10 coding against clinical documentation and applicable guidelines.
• Conduct investigative research related to healthcare fraud schemes, utilization review, and SIU operations.
• Prepare analytical reports and maintain detailed case documentation.

Requirements

• AS or BS in Nursing or a similar field.
• Current RN or LPN qualification.
• At least 2 years of experience reviewing medical records or healthcare documentation.
• Knowledge of medical terminology, anatomy, physiology, CPT, HCPCS, ICD-10, HIPAA, OIG guidelines, and CMS regulations.
• Experience with EMR/EHR systems, Microsoft Office, and data analysis or reporting tools.
• Must reside in MD, DC, PA, DE, WV, VA, or NC and be available onsite in Elkridge, Maryland, for the first 1–2 weeks.

Nice to have

• Claims processing systems experience.
• Certifications such as CPC, CCS, RHIT, RHIA, CFE, AHFI, or CPMA.

Culture & Benefits

• Remote work after the initial onsite training period.
• Initial onsite collaboration and training in Elkridge, Maryland.