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Hospital Claims Adjuster
4 months ago
The Hospital Claims Adjuster is responsible for the adjusting of hospital risk claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospitals/IPAs. Research, reviews, and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.
Duties and Responsibilities
· Accurately review all incoming adjustment requests to verify necessary information is available.
· Meets production and accuracy standards established by claims management.
· Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims.
· Coordinate resolution of claims issues with other Departments.
· Assist Providers and other Departments in claims research.
· Review and adjudicate web portal inquiries.
· Assist in training claims personnel when issues are identified.
· Promote a spirit of cooperation and understanding among all personnel.
· Attend organizational meetings as required
· Adhere to organizational policies and procedures.
· Performs other tasks as assigned by Claims Leadership.
· Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
Minimum Job Requirements
· High School Graduate
· Minimum 1 year experience as a Claims Examiner II
· One year experience with Hospital/Facility risk claims
Skill and Abilities
· Knowledge of DOFR interpretation and the adjudication of hospital risk claims.
· Ability to get work done efficiently and within timeliness guidelines.
· Experience in a managed care environment preferred.
· ICD-9 and ICD-10 and CPT-4 coding knowledge preferred.
· Must be detail oriented and can work independently
