Claims Investigator jobs in Dayton, OH

Job Summary:

We are seeking a skilled and detail-oriented Claims Investigator to join our team. As a Claims Investigator, you will be responsible for reviewing and analyzing medical claims to ensure accuracy and compliance with insurance policies and procedures. Your expertise in medical coding, billing, and terminology will play a crucial role in identifying potential fraudulent activities and resolving claim disputes. If you have a strong background in medical office operations and possess excellent analytical and problem-solving skills, we encourage you to apply.

Responsibilities: -

Review and analyze medical claims for accuracy, completeness, and compliance with insurance policies - Conduct investigations into suspicious or potentially fraudulent claims. Follow up on claims that have not paid within 30 days to get claims paid.

Stay updated on industry regulations, coding guidelines, and best practices related to claims investigation

Qualifications: -

Previous experience in healthcare administration, medical billing/coding, or a related field. - Strong knowledge of medical terminology, ICD-10 coding systems, DRG classification, and medical billing processes - Experience working in a medical office or healthcare setting is highly desirable - Familiarity with medical records management and electronic health record (EHR) systems - Excellent analytical skills with the ability to identify discrepancies and patterns in claim data - Detail-oriented with strong organizational skills to manage multiple investigations simultaneously - Effective communication skills to collaborate with internal teams and external stakeholders - Proficient in using computer systems/software for data analysis and reporting

Job Types: Full-time, Part-time

Pay: $41,000.00 - $45,000.00 per year

Expected hours: 20 – 40 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off

Schedule:

• Monday to Friday

Work setting:

• In-person

Experience:

• Billing office: 1 year (Required)
• Investigating insurance claims: 1 year (Required)

Ability to Relocate:

• Clarksville, OH 45113: Relocate before starting work (Required)

Work Location: In person