Special Investigative Unit Investigator

Job Summary

A company is looking for a Special Investigative Unit Prepay Investigator.

Key Responsibilities:

• Triage claims data for medical coding review to ensure adherence to PHI policies
• Review medical records to gather relevant facts for investigations and communications
• Ensure compliance with state and federal policies, reimbursement policies, and contract compliance

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age or older
• 2+ years of experience in claims processing, provider medical records, or insurance billing practices
• 1+ years of experience using claim platforms
• Intermediate experience with Microsoft Office, specifically Excel and Word