Hospital Claims Adjuster
Posted 2025-03-14The 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
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