Medical Claims Investigator
Company: VirtualVocations
Location: Vista
Posted on: May 24, 2025
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Job Description:
A company is looking for a Medical Claims Investigator.
Key Responsibilities
Review medical paid claims against provider contracts and policies
for accuracy
Utilize analytics and data mining techniques to analyze hospital
and physician claims
Ensure compliance with HIPAA regulations while promoting a positive
team environment
Required Qualifications, Training, and Education
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 are preferred
Knowledge of coding edits and medical claim reimbursement
methodologies
Experience with federal/state regulations and policies related to
coding and billing
Familiarity with automated medical claims payment systems and
advanced computer skills
Keywords: VirtualVocations, Fullerton , Medical Claims Investigator, Healthcare , Vista, California
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