Medical Claims Reviewer

What role you will play in team: Review medical claims for accuracy and compliance with guidelines.

What you will do: Verify medical necessity, coding accuracy, and documentation completeness.

Key responsibility:

• Reviewing medical claims for accuracy and completeness.
• Verifying medical necessity and appropriateness of services.
• Ensuring compliance with regulatory guidelines and payer contracts.
• Identifying and resolving discrepancies.

• Maintaining accurate records of all claim review activities.
• Collaborating with other reviewers and medical staff.

Required Qualification and Skills:

• Bachelor's degree in Healthcare Administration or related field preferred.
• Experience in medical claims review is a plus.
• Knowledge of medical terminology and coding (ICD-10, CPT).
• Excellent analytical and problem-solving skills.
• Strong attention to detail.

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Benefits Included:

• Competitive salary and benefits package.
• Opportunities for professional growth.
• A collaborative and supportive team environment.
• Health Insurance
• Paid Time Off

A Day in the Life: A typical day involves reviewing medical claims, verifying information, identifying discrepancies, and collaborating with other reviewers.