Medical Claim Adjuster

Larkin Community Hospital • South Miami, FL

3h

About The Position

Under the direction of the Business Office Director, the Medical Claim Adjuster is responsible for reviewing and adjusting accounts in accordance with claims processing guidelines.

Requirements

• High School diploma of equivalent (additional certifications or education in medical billing/coding preferred)
• 1-2+ year’s claims processing experience.
• Strong understanding of medical terminology, CPT codes, ICD-10 codes, and insurance billing guidelines.
• Excellent numerical and analytical skills, with a keen eye to detail.
• Ability to interpret insurance EOBs and payment information accurately.
• Strong problem-solving skills, with the ability to reconcile discrepancies and resolve payment-related issues effectively.

Responsibilities

• Perform adjustments using technical and claims processing expertise.
• Identify discrepancies in payments, adjust accounts based on expected amount.
• Review and interpret contract language using provider contracts to confirm whether a claim is overpaid or underpaid.
• Review denials and ensures posting reflects the appropriate denial reason code.
• Review and handle relevant correspondences assigned to the team that may result in adjustments to accounts.
• Preforms related duties as required.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees