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    Hospital Claims Examiner - Los Angeles, United States - MedPOINT Management

    MedPOINT Management
    MedPOINT Management Los Angeles, United States

    3 weeks ago

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    Description

    Job Description

    The claims examiner's role involves processing claims, ensuring compliance with regulations and contractual agreements. They investigate and address problematic claims, suggesting enhancements to the process. Additionally, they serve as a valuable information source for the team.

    Duties and Responsibilities

    • Accurately review all incoming Provider claims to ensure data accuracy.
    • Meet claims management's production standards.
    • Adjudicate claims following departmental policies and specialized regulations.
    • Collaborate with other departments to resolve claims issues.
    • Assist in claims research for Providers, Members, and other teams.
    • Offer support to fellow examiners and participate in training new staff.
    • Foster cooperation and mutual understanding within the team.
    • Participate in organizational meetings and uphold company policies.
    • Perform additional assignments as delegated by supervisor/manager.
    • Embrace MedPOINT Management's core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration.

    Minimum Job Requirements

    Applicants should be high school graduates with at least one year of experience as a Claims Examiner using automated claims systems. Strong organizational and mathematical aptitude are essential.

    Skills and Abilities

    • Preference for experience in managed care settings.
    • Prior knowledge of ICD-10 and CPT-4 coding is advantageous.
    • Attention to detail and the capability to work autonomously are critical.
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