Hospital Claims Adjuster
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AI Summary
The role involves reviewing, analyzing, and adjudicating inpatient and outpatient hospital claims according to plan guidelines. It also requires coordinating with providers and internal departments to resolve claim discrepancies and ensure regulatory compliance.
Benefits:
- 401(k)
- 401(k) matching
- Bonus based on performance
- Dental insurance
- Employee discounts
- Free food & snacks
- Health insurance
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
- Vision insurance
- Wellness resources
About the Role:
MedPOINT Management in Sherman Oaks, CA is looking for a detail-oriented Hospital Claims Adjuster to join our dynamic healthcare team. In this role, you'll play a critical part in reviewing and processing hospital claims with accuracy and efficiency. If you're passionate about healthcare operations and thrive in a fast-paced environment, we want to hear from you!
Responsibilities:
- Review, analyze, and adjudicate inpatient and outpatient hospital claims in accordance with plan guidelines
- Verify patient eligibility, benefits, and coverage prior to claims processing
- Identify and resolve claim discrepancies, denials, and underpayments
- Apply ICD-10, CPT, and DRG coding knowledge to ensure accurate claim adjudication
- Coordinate with providers, hospitals, and internal departments to resolve claim issues
- Ensure compliance with state and federal healthcare regulations, including HIPAA
- Maintain accurate documentation and meet productivity and quality benchmarks
Requirements:
- 2+ years of experience in hospital or medical claims adjudication
- Proficiency in ICD-10, CPT, HCPCS, and DRG coding
- Familiarity with managed care, HMO, PPO, and IPA claims processing
- Strong knowledge of EOB preparation and explanation of benefits
- Experience with claims management software and healthcare information systems
- Excellent analytical, problem-solving, and organizational skills
- Strong attention to detail with the ability to meet deadlines in a high-volume environment
About Us:
MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to delivering high-quality administrative and managed care services to healthcare providers across Southern California. Our clients trust us for our expertise, responsiveness, and commitment to operational excellence. Our employees thrive in a collaborative, mission-driven workplace where their contributions directly impact the quality of patient care.
This is a remote position.
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