Hospital Claims Adjuster

The 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 Apply Job!