Medical Claims Investigator

Job Summary

A company is looking for a Medical Claims Investigator.

Key Responsibilities

• Review medical paid claims against provider contracts and policies for accuracy
• Utilize data mining and coordination of benefits techniques to analyze hospital and physician claims
• Ensure compliance with HIPAA regulations and collaborate across departments

Required Qualifications

• Minimum 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 in a relevant field are preferred
• Knowledge of coding edits and medical claim reimbursement structures
• Experience with federal/state regulations and policies related to coding and billing
• Familiarity with automated medical claims payment systems and advanced computer skills