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.