JOB TITLE: Medical Claim Adjuster DEPARTMENT: Patient Accounts SUPERVISOR: Business Office Director
Larkin Health System is an integrated healthcare delivery system accredited by the Joint Commission with locations in South Miami, Hialeah, and Hollywood, Florida. Our network of acute care hospitals provides a complete continuum of healthcare services, including a full range of inpatient and outpatient services, and home health agencies in Miami-Dade and Broward County. We are heavily invested in training the next generation of health professionals, which is the core of our mission: to provide access to compassionate care of the highest quality in an educational environment.
GENERAL JOB DESCRIPTION
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.
DUTIES AND 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. • Performs related duties as required.
QUALIFICATIONS FOR THE JOB
Education: High School diploma of equivalent (additional certifications or education in medical billing/coding preferred)
Experience: 1-2+ years of claims processing experience
Other: 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.