Senior Medical Claims Investigator

Job Summary

A company is looking for a Senior Medical Claims Investigator (remote).

Key Responsibilities

• Review medical claims against provider contracts and policies for accuracy
• Utilize data mining techniques to analyze claims and identify savings opportunities
• Mentor junior team members and assist in achieving departmental quality and revenue goals

Required Qualifications, Training, and Education

• Minimum high school diploma or GED with four years of experience in medical claims investigation
• Relevant medical billing and coding certification and a bachelor's degree are highly preferred
• Advanced knowledge of coding edits and medical claim reimbursement structures
• Extensive experience with federal/state regulations and policies related to coding and billing
• Proficiency with automated medical claims payment systems and Microsoft Excel