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Hospital Claims Examiner
3 months ago
Job DescriptionJob Description
The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, 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.
Want to make an application Make sure your CV is up to date, then read the following job specs carefully before applying.Duties and Responsibilities
· Accurately review all incoming Provider claims to verify necessary information is available.
· Meets production standards of 100-150 claims as established by claims management
· Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
· Coordinate resolution of claims issues with other Departments.
· Assist Providers, Members and other Departments in claims research.
· Provide backup for other examiners within the Department.
· Assist in training of new claims personnel.
· 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 supervisor/manager
· Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
Minimum Job Requirements
High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills.
Skill and Abilities
· Experience in a managed care environment preferred.
· ICD-10 and CPT-4 coding knowledge preferred.
· Must be detail oriented and have the ability to work independently
