10 Hospital Claims Examiner Jobs in Los Angeles, CA
MEDPOINT MANAGEMENT is Hiring a Hospital Claims Examiner Near Los Angeles, CA
Job Description
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
Job Summary
Full Time
$66k-85k (estimate)
06/30/2024
07/15/2024
medpointmanagement.com
WOODLAND HILLS, CA
25 - 50
1988
SHELDON LEWENFUFF PREIDENT
$10M - $50M
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About MEDPOINT MANAGEMENT
MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base.
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