Senior Medical Claims Investigator

A company is looking for a Sr. Medical Claims Investigator. Key Responsibilities Review medical claims against provider contracts to ensure accurate processing of payments Utilize data mining techniques to identify coding and pricing errors in medical claims Assist in training and mentoring junior team members while managing productivity and quality goals Required Qualifications High school diploma or GED with four years of experience in medical claims investigation or auditing Relevant medical billing and coding certification is highly preferred Advanced knowledge of coding edits and medical claim reimbursement methodologies Expertise in COB NAIC Guidelines and federal/state healthcare regulations Proficiency in Microsoft Excel and familiarity with automated medical claims payment systems

Mar 22, 2025 - 06:43

A company is looking for a Sr. Medical Claims Investigator. Key Responsibilities Review medical claims against provider contracts to ensure accurate processing of payments Utilize data mining techniques to identify coding and pricing errors in medical claims Assist in training and mentoring junior team members while managing productivity and quality goals Required Qualifications High school diploma or GED with four years of experience in medical claims investigation or auditing Relevant medical billing and coding certification is highly preferred Advanced knowledge of coding edits and medical claim reimbursement methodologies Expertise in COB NAIC Guidelines and federal/state healthcare regulations Proficiency in Microsoft Excel and familiarity with automated medical claims payment systems