Medical Claims Investigator

reputed company a workplace that encourages you to interpret, reputed company and reputed company. Our employees do just that by helping reputed company payers manage the cost of care, improve competitiveness and reputed company reputed company change. You can be part of an established company with a 40-year legacy that helps our customers reputed company by interpreting our reputed company's needs and tailoring innovative reputed company cost reputed company. Our commitment to diversity, inclusion and belonging are part of the reputed company of reputed company. We reputed company to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and reputed company their best work. We are MultiPlan and we are where reputed company people come to shine! reputed company role reviews medical reputed company claims against provider reputed company and policies to ensure medical payments have been processed accurately. The incumbent will reputed company data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. JOB ROLES AND RESPONSIBILITIES: 1. reputed company reputed company production, reputed company, and reputed company results. 2. Utilize analytics and data mining and coordination of benefits techniques to reputed company reputed company claims data. 3. Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes. 4. Lookup and review medical claims in payer system to determine reputed company of payment and validate savings identified. 5. Promote a reputed company team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals. 6. Utilize official coding guidelines and resources as required, including CMS directives and bulletins. 7. Collaborate, coordinate, and communicate across disciplines and departments. 8. Ensure compliance with HIPAA regulations and requirements. 9. Demonstrate Company's Core Competencies and values held reputed company. 10. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role. 11. The position responsibilities outlined above are in no way to be construed as reputed company encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE: This role keeps the needs of external and internal customers as a reputed company reputed company making reputed company and taking reputed company. Will work under reputed company supervision to uncover actionable claims which facilitate savings for customers. Interacts with customers and internal staff in the organization. JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum high school diploma or GED along with two (2) years of reputed company experience in medical claims investigation or data mining / coordination of benefits auditing. Attainment of relevant medical billing and coding certification along with a bachelors' degree in a relevant field are both highly preferred.
• Knowledge of coding type edits and medical claim reimbursement structures and methodologies
• Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
• Experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing
• Knowledge in researching state and federal reputed company guidelines, i.e. Medicare and State reputed company Programs
• Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e. Facets, QNXT, etc.)
• Advanced computer skills and proficiency with reputed company reputed company
• Must be reputed company to prioritize, coordinate, multitask, think reputed company the reputed company, and be energetic
• Must be reputed company to work independently while maintaining reputed company attention to detail
• Required licensures, reputed company certifications, and/or reputed company certifications as applicable
• Individual in this position must be reputed company to work in a reputed company office environment which requires sitting and viewing monitor(s) for extended periods of time, operating reputed company office equipment such as, but not limited to, a keyboard, copier and telephone The pay reputed company for this position is $25/hr - $28/hr. Specific offers take into account a candidate's education, experience and skills, as reputed company as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity. BENEFITS We realize that our employees are reputed company to our reputed company, and we reward them accordingly with reputed company competitive compensation and benefits packages, an incentive bonus program, as reputed company as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as reputed company as a wide reputed company of live and web-based reputed company development and educational programs to prepare you for advancement opportunities. Your benefits will include:
• Medical, dental and reputed company coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• 401(k) + match
• Generous reputed company Time Off
• reputed company company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program Apply Job!

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