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Healthcare Claims Specialist
1 month ago
MedPOINT Management is seeking a highly skilled and detail-oriented Hospital Claims Examiner to join our team.
Job SummaryThe Hospital Claims Examiner will be responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. This role requires strong organizational and mathematical skills, as well as the ability to work independently and as part of a team.
Key Responsibilities- Accurately review all incoming Provider claims to verify necessary information is available.
- Meet 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.
- Perform other tasks as assigned by supervisor/manager.
- High school graduate.
- One-year experience as a Claims Examiner on an automated claims adjudication system.
- Strong organizational and mathematical skills.
- 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.
MedPOINT Management offers a competitive salary and benefits package, as well as opportunities for professional growth and development.
We are an equal opportunity employer and welcome applications from diverse candidates.
