Medicare Fraud Investigator Resume

As the cost of fighting diseases is rising, many scams are cropping up in the medical field. Though Medicare provide most of the facilities for health care, there are certain things that are not covered under the claim clause. To recover such money, people simply apply illegal measures. This brings the necessity of Medicare fraud investigators. Many hospitals, insurance companies, and the Medicare itself appoint these investigators to find the fraud happening in the healthcare field.

If unearthing scams and calling yourself a detective are things that you always fancied, you can have a rewarding career as a Medicare fraud investigator. Of course, education and experience are highly considered for this job. If these criteria are already fulfilled by you, here is a sample resume you can use for applying.

Medicare Fraud Investigator Resume Example

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Anthony Meyer
15, Mariplex Street
Arlington, TX 87714
Telephone Number: 788 - 030 - xxxx
Email Id: anthonymeyer@example.com

Career Objective:

To obtain a Medicare Fraud Investigator position with “ProgressiveMed” and conduct comprehensive evaluation of submitted claims, medical records, and supporting documents.

Summary of Skills:

• Experienced in identifying fraud happening under the Medicare program
• Excellent understanding of data analysis techniques and statistics
• Good knowledge of laws and regulations related to medical industry
• Skilled in conducting research and drawing conclusions
• Expert in citing regulatory violations, and unnecessary inflating of medical bills
• Ability to get to the depth of fraud schemes initiated for defrauding the Government
• Remarkable computer, communication, and interpersonal skills

Work Experience:

Medicare Fraud Investigator
Arlington Hospital, Arlington, TX
March 2012 - Present

• Investigate independently all fraud schemes and claims
• Identify discrepancies in Medicare claim data
• Find out the trails of fraud scams and get to the real source of origin
• Proceed paperworks to recovered overpaid money
• Detect unnecessary inflation of billing and abuse of medical practice
• Develop and implement system that detect potent fraud scheme
• Conduct audits in cooperation with the investigation development

Medicare Fraud Investigator
Hope Medicare Center, Arlington, TX
August 2010 - February 2012

• Utilized data analysis techniques and identified discrepancies in Medicare claims data
• Reviewed standard claims processing systems files and detected potential fraudulent acts
• Collected, compiled, and analyzed medical records and billing copies
• Checked the rates charges for each services and verified with the billing code
• Communicated with patients and guided them on filling claim forms
• Supported the hospital staff in abuse case by gathering evidence in their favor
• Reported errors in billing to the higher authority and issued warning to the billing clerk

Education:

• Bachelor's Degree in Hospital Manager
  Arlington University, Arlington, TX
  2009

Reference:

On request.