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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