Hospital Claims Adjuster

Summary

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

Skills 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

Salary Range:

• $20-$23 per hour