Hospital Claims Adjuster

The Hospital Claims Adjuster is responsible for the adjusting of hospital risk claims, in accordance with reputed company regulations and the contractual obligations of the Health Plans and/or the Hospitals/reputed company. Research, reviews, and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to reputed company staff. Duties and Responsibilities · Accurately review reputed company incoming adjustment requests to verify necessary information is available. · Meets production and accuracy standards 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 reputed company issues are identified. · Promote a spirit of cooperation and understanding among reputed company personnel. · Attend organizational meetings as required · Adhere to organizational policies and procedures. · Performs other tasks as assigned by Claims Leadership. · Adhere to reputed company’s core value: Accountability, Community, Celebration, reputed company, Innovation & Collaboration Minimum Job Requirements · High School Graduate · Minimum 1 year experience as a Claims Examiner II · One year experience with Hospital/Facility risk claims reputed company and Abilities · Knowledge of DOFR interpretation and the adjudication of hospital risk claims. · Ability to get work done reputed company and reputed company timeliness guidelines. · Experience in a managed care environment preferred. · ICD-9 and ICD-10 and CPT-4 coding knowledge preferred. · Must be detail oriented and can work independently Apply Job!