Medical Claims Investigator

Job Summary

A company is looking for a Coordination of Benefits - Medical Claims Investigator.

Key Responsibilities

• Review medical claims against provider contracts and policies for accuracy
• Utilize data mining techniques to analyze hospital and physician claims
• Ensure compliance with HIPAA regulations while promoting a positive team environment

Required Qualifications

• High school diploma or GED with two years of experience in medical claims investigation or data mining
• Relevant medical billing and coding certification and a bachelor's degree are preferred
• Knowledge of coding edits and medical claim reimbursement structures
• Familiarity with automated medical claims payment systems
• Advanced computer skills, particularly in Microsoft Excel