Job Details

A company is looking for a Sr Medical Claims Investigator- Coordination of Benefits.Key ResponsibilitiesReview medical claims against provider contracts and policies to ensure accurate payment processingUtilize data mining and coordination of benefits techniques to identify savings opportunities in paid claims dataMentor junior team members and assist in managing productivity and achieving quality and revenue goalsRequired QualificationsMinimum high school diploma or GED with four years of relevant experience in medical claims investigation or auditingAdvanced knowledge of coding edits and medical claim reimbursement structuresExpertise in COB NAIC Guidelines and familiarity with automated medical claims payment systemsRelevant medical billing and coding certification and a bachelor's degree in a related field are highly preferredExtensive experience in applying coding guidelines and federal/state regulations related to billing