Medical Claims Examiner

We are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. The ideal candidate has strong working knowledge of ICD‑9 and ICD‑10 diagnosis coding and healthcare billing standards.

Key Responsibilities:

• Review and process medical claims for completeness, accuracy, and compliance
• Apply ICD‑9 and ICD‑10 codes to evaluate claim validity
• Identify coding discrepancies, overpayments, and potential fraud or abuse
• Ensure claims adhere to payer policies, CMS guidelines, and regulatory requirements
• Document determinations and communicate findings as needed

Qualifications:

• Proven experience as a Medical Claims Examiner or similar role
• Strong knowledge of ICD‑9 and ICD‑10 coding
• Familiarity with CPT, HCPCS, and medical billing guidelines
• Attention to detail and strong analytical skills
• Proficiency with claims processing systems and MS Office

Preferred:

• CPC, CCS, or related certification
• Experience with Medicare, Medicaid, or commercial insurance claims