Medical Claims Investigator

A company is looking for a Medical Claims Investigator. Key Responsibilities Review medical paid claims against provider contracts and policies for accuracy Utilize data mining and coordination of benefits techniques to analyze hospital and physician claims Ensure compliance with HIPAA regulations and collaborate across departments Required Qualifications Minimum high school diploma or GED with two years of experience in medical claims investigation or data mining Relevant medical billing and coding certification and a bachelor's degree in a relevant field are preferred Knowledge of coding edits and medical claim reimbursement structures Experience with federal/state regulations and policies related to coding and billing Familiarity with automated medical claims payment systems and advanced computer skills