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Claims Examiner
2 months ago
MedPOINT Management is seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for accurately reviewing and processing medical claims in accordance with regulatory guidelines and company policies.
Key Responsibilities- Review and verify incoming provider claims to ensure all necessary information is available.
- Meet production standards of 100-150 hospital claims per day and 200-250 IPA claims as established by claims management.
- Assist in other IPA's as needed.
- Enter claims data information into the computerized claims adjudication system.
- Maintain all required documentation of claims processed and claims on hand.
- Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
- Maintain production standards established by claims management.
- Coordinate resolution of claims issues with other Departments or Payers.
- 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.
- Process Customer Care Inquires.
- 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.
- Ability to generate claims status reports and/or check runs.
- Experience in a managed care environment.
- ICD-9 and ICD-10 and CPT-4 coding knowledge.
- Must be detail oriented and have the ability to work independently.
