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. Researches, 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.
• 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
• Meets production and accuracy standards established by claims management.

Minimum Job Requirements and Experience

High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. One-year experience adjudicating hospital risk claims. Strong organizational and mathematical skills. Ability to get work done efficiently and within timeliness guidelines.

Knowledge, Skills and Abilities

• Knowledge of DOFR interpretation and the adjudication of hospital risk claims.
• Experience in a managed care environment preferred.
• ICD-9 and ICD-10 and CPT-4 coding knowledge preferred.
• Must be detail oriented and have the ability to work independently

Salary Range

• $20 - $23 per hour