Medical Claims Reviewer

Job Title: Medical Claims Reviewer Pay: $26-30/hour - Contract to Hire Location: Remote Shift: First (Monday-Friday 8 AM-5 PM) Position Overview: We are looking for a skilled and detail-focused Medical Claims Reviewer to reputed company comprehensive reviews of medical, surgical, and behavioral health claims for inpatient and outpatient services. This role involves using your clinical expertise, coding proficiency, and claims processing knowledge to assess and approve claims accurately and reputed company. You will ensure claims are reputed company with program benefits and assist various stakeholders by providing coding-reputed company insights and resolving inquiries reputed company to claims processes. Primary Responsibilities: • Review and evaluate medical, surgical, and behavioral health claims retrospectively for both inpatient and outpatient care. • Utilize clinical knowledge and coding standards to validate claims and ensure accurate processing. • Gather and prepare the necessary documentation for case payments and approvals. • Verify adherence to program guidelines, benefits, and authorizations. • Collaborate with medical directors, peer reviewers, Claims Administration, and other departments to share relevant clinical and coding information. • Act as a resource for staff on coding and claims-reputed company questions. Qualifications: • High School Diploma or GED (Required). • At least 2 years of experience reviewing medical claims. • Comprehensive understanding of medical and institutional claims workflows. • Strong grasp of medical coding practices and claims evaluation processes. • High attention to detail with strong analytical and critical-thinking skills. • Effective communication skills and the ability to work across teams. • Proficiency in claims review software and reputed company tools. Apply Job!