Senior Medical Claims Investigator

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