Senior Medical Claims Investigator

Job Summary

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

Key Responsibilities

• Review medical claims against provider contracts and policies to ensure accurate payment processing
• Utilize data mining and coordination of benefits techniques to identify savings opportunities in paid claims data
• Mentor junior team members and assist in managing productivity and achieving quality and revenue goals

Required Qualifications

• Minimum high school diploma or GED with four years of relevant experience in medical claims investigation or auditing
• Advanced knowledge of coding edits and medical claim reimbursement structures
• Expertise in COB NAIC Guidelines and familiarity with automated medical claims payment systems
• Relevant medical billing and coding certification and a bachelor's degree in a related field are highly preferred
• Extensive experience in applying coding guidelines and federal/state regulations related to billing