Job Description

Job Description

Job Description

Summary

The claims adjuster is responsible for the adjusting of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the 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.

· Meets production standards of 20-100 claims as 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 supervisor/manager

· Adhere to MedPOINT Management’s core value: 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. Ability to get work done efficiently and within timeliness guidelines.

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

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