Hospital Claims Adjuster

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🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $23 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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MedPOINT Management

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1988

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

MedPOINT Management is a California-based healthcare management services organization that supports independent practice associations (IPAs), provider networks, hospitals and contracted health plans with clinical quality, care management, administrative operations and technology solutions. For more than 32 years MPM has provided services including provider network operations, case management, utilization management, claims operations, credentialing, HEDIS/STARs quality measurement and analytics (via Cozeva), call center and financial management, and digital provider portals and resource libraries. The company emphasizes data security and compliance (SOC 2 and HITRUST e1 certifications for its EZ-CAP and Provider Web Portals) and focuses on enabling value-based care, quality improvement, and operational support for providers and payers.

📋 Description

• 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

🏖️ 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