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 analytics and data mining techniques to analyze hospital and physician claims
• Ensure compliance with HIPAA regulations while promoting a positive team environment

Required Qualifications

• Minimum high school diploma or GED with two years of experience in medical claims investigation or data mining
• Preferred medical billing and coding certification and bachelor's degree in a relevant field
• Knowledge of coding type edits and medical claim reimbursement structures
• Familiarity with automated medical claims payment systems and payer systems
• Advanced computer skills, particularly in Microsoft Excel