Hospital Claims Adjuster

7 hours ago


Los Angeles, California, United States MedPOINT Management Full time
Job Summary

We are seeking a skilled Hospital Claims Adjuster to join our team at MedPOINT Management. As a key member of our claims team, you will be responsible for the adjusting of hospital risk claims, ensuring compliance with outside regulations and contractual obligations.

Key Responsibilities
  • Accurately review incoming adjustment requests to verify necessary information.
  • Meet production and accuracy standards established by claims management.
  • Adjust claims in accordance with departmental policies and procedures.
  • 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.
Requirements
  • High School Graduate
  • Minimum 1 year experience as a Claims Examiner II
  • One year experience with Hospital/Facility risk claims
Preferred Qualifications
  • 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.
About MedPOINT Management

MedPOINT Management is a leading provider of healthcare services, committed to delivering high-quality care to our patients. We are dedicated to creating a positive and supportive work environment for our employees, and we are seeking individuals who share our values of accountability, community, celebration, integrity, innovation, and collaboration.


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