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Hospital Claims Examiner
Hospital Claims ExaminerMedPOINT Management • Sherman Oaks, CA, US
Hospital Claims Examiner

Hospital Claims Examiner

MedPOINT Management • Sherman Oaks, CA, US
30+ days ago
Job type
  • Full-time
Job description
Benefits:
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Vision insurance
  • Wellness resources

The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. 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 Provider claims to verify necessary information is available.


· Meets production standards of 100-150 claims as established by claims management


· Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.


· Coordinate resolution of claims issues with other Departments.


· 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.


· Performs other tasks as assigned by supervisor/manager


· Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration



Minimum Job Requirements


High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills.



Skill and Abilities


· Experience in a managed care environment preferred.


· ICD-10 and CPT-4 coding knowledge preferred.


· Must be detail oriented and have the ability to work independently

This is a remote position.

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Hospital Claims Examiner • Sherman Oaks, CA, US

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