Medical Claims Examiner

JOB DESCRIPTION

Hybrid/ Full Time (Must be able to go onsite for training the first two weeks) A national healthcare consulting and claims administration organization is adding a Medical Claims Examiner due to continued growth and increased client volume. On a daily basis, you will review professional and facility medical claims for accuracy, medical necessity, and policy alignment. You'll interpret clinical documentation and coding to determine appropriate payment outcomes, identify discrepancies or potential overbilling, and communicate decisions to providers and internal partners.

REQUIRED SKILLS AND EXPERIENCE

• 2+ years of hands-on medical claims examination or healthcare billing experience
• Strong working knowledge of ICD-10, CPT, and HCPCS coding
• Experience reviewing medical records and determining medical necessity
• Familiarity with payer policies, benefit plans, and reimbursement methodologies
• Ability to clearly document and communicate claim decisions
• Comfortable working in claims systems and Microsoft Office

NICE TO HAVE SKILLS AND EXPERIENCE

• CPC, CPMA, CCS, or similar certification
• Experience with claim audits, appeals, or complex claim reviews
• Exposure to CMS guidelines or regulatory-driven claims environments
• Prior work in a consulting, TPA, or managed care setting

Compensation: $45,000/yr to $55,000/yr