MedPOINT Management

Role Description 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 Qualifications - 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 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

Role Description Join MedPOINT Management as a Claims Processor in Sherman Oaks, CA, where you will play a crucial role in our dynamic team. This position offers an exciting opportunity to work in a fast-paced environment while ensuring accurate and timely processing of claims. Responsibilities: - Review and process insurance claims with accuracy and efficiency. - Ensure compliance with company policies and regulatory requirements. - Communicate with clients and insurance companies to resolve claims discrepancies. - Maintain detailed records of claims processing activities. - Analyze claims data to identify trends and areas for improvement. - Assist in training new team members on claims processing procedures. - Participate in team meetings to discuss workflow and process enhancements. - Stay updated on industry changes and best practices related to claims processing. Qualifications - High school diploma or equivalent; associate degree preferred. - Minimum of 2 years experience in claims processing or related field. - Strong attention to detail and excellent organizational skills. - Proficient in claims management software and Microsoft Office Suite. - Ability to work independently and collaboratively in a team environment. - Effective communication skills, both written and verbal. - Knowledge of medical terminology and insurance policies is a plus. - Strong problem-solving skills and ability to handle challenging situations. Requirements - High school diploma or equivalent; associate degree preferred. - Minimum of 2 years experience in claims processing or related field. - Strong attention to detail and excellent organizational skills. - Proficient in claims management software and Microsoft Office Suite. - Ability to work independently and collaboratively in a team environment. - Effective communication skills, both written and verbal. - Knowledge of medical terminology and insurance policies is a plus. - Strong problem-solving skills and ability to handle challenging situations. Benefits - 401(k) - 401(k) matching - Company parties - Dental insurance - Employee discounts - Health insurance - Opportunity for advancement - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources Company Description MedPOINT Management has been a leader in healthcare management for over a decade, providing exceptional services to our clients. Our commitment to excellence and innovation is why customers love us, and our supportive work environment is why employees thrive here.

Role Description Join MedPOINT Management as an Outpatient UM Clinician in Sherman Oaks, CA, where you will play a vital role in ensuring quality care for our patients. Be part of a dynamic team dedicated to improving patient outcomes through effective utilization management. Responsibilities: - Conduct utilization reviews for outpatient services to ensure compliance with standards. - Collaborate with healthcare providers to assess patient needs and treatment plans. - Document and track patient progress and treatment outcomes. - Communicate with insurance companies regarding authorizations and appeals. - Provide education and support to patients and families regarding care options. - Participate in quality improvement initiatives to enhance service delivery. - Stay updated on industry regulations and best practices in utilization management. - Assist in training and mentoring new staff on UM processes. Qualifications - Licensed clinician with a background in nursing, social work, or a related field. - Minimum of 2 years of experience in utilization management or case management. - Strong understanding of healthcare regulations and insurance processes. - Excellent communication and interpersonal skills. - Ability to work collaboratively in a fast-paced environment. - Proficient in electronic health records and documentation practices. - Detail-oriented with strong analytical and problem-solving skills. - Commitment to patient-centered care and quality improvement. Requirements - Licensed clinician with a background in nursing, social work, or a related field. - Minimum of 2 years of experience in utilization management or case management. - Strong understanding of healthcare regulations and insurance processes. - Excellent communication and interpersonal skills. - Ability to work collaboratively in a fast-paced environment. - Proficient in electronic health records and documentation practices. - Detail-oriented with strong analytical and problem-solving skills. - Commitment to patient-centered care and quality improvement. Benefits - 401(k) - 401(k) matching - Company parties - 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 Company Description MedPOINT Management has been a leader in outpatient management solutions for over a decade. Our commitment to quality care and patient satisfaction has earned us the trust of both our clients and employees, creating a supportive and rewarding work environment.

Role Description Join MedPOINT Management as a Member Outreach Representative in Sherman Oaks, CA, where you'll play a vital role in connecting with our valued members. This position offers an exciting opportunity to enhance member engagement and contribute to our mission of providing exceptional healthcare management services. Responsibilities: - Engage with members through various communication channels to promote services and gather feedback. - Assist members with inquiries and provide information regarding healthcare plans and benefits. - Develop and maintain strong relationships with members to enhance satisfaction and retention. - Collaborate with internal teams to ensure member needs are met effectively. - Track outreach efforts and report on member engagement metrics. - Participate in community events to promote MedPOINT services and foster relationships. - Identify opportunities for improving member experience and service delivery. Qualifications - High school diploma or equivalent; degree in healthcare or communications preferred. - 1-2 years of experience in customer service or outreach roles. - Excellent communication and interpersonal skills. - Strong organizational skills with attention to detail. - Ability to work independently and as part of a team. - Proficient in Microsoft Office and CRM software. - Passion for helping others and a commitment to enhancing member experiences. Requirements - High school diploma or equivalent; degree in healthcare or communications preferred. - 1-2 years of experience in customer service or outreach roles. - Excellent communication and interpersonal skills. - Strong organizational skills with attention to detail. - Ability to work independently and as part of a team. - Proficient in Microsoft Office and CRM software. - Passion for helping others and a commitment to enhancing member experiences. Benefits - 401(k) - 401(k) matching - Company parties - Dental insurance - Employee discounts - Health insurance - Opportunity for advancement - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources

Role Description Join MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll play a crucial role in ensuring the quality and accuracy of medical claims. This is an exciting opportunity to work in a dynamic environment that values clinical expertise and attention to detail. - Conduct thorough clinical reviews of medical claims to ensure compliance with policies and regulations. - Collaborate with healthcare providers to clarify information and resolve discrepancies. - Utilize clinical knowledge to assess the medical necessity of services rendered. - Document findings and recommendations clearly and accurately in the claims management system. - Participate in training and development initiatives to enhance team performance. - Stay updated on industry trends, regulations, and best practices related to medical claims. - Provide support and guidance to claims processing teams as needed. - Assist in the development of clinical review policies and procedures. Qualifications - Registered Nurse (RN) license in California is required. - Minimum of 3 years of clinical nursing experience, preferably in a hospital or healthcare setting. - Experience in medical claims review or utilization management is a plus. - Strong analytical skills with attention to detail and accuracy. - Excellent communication and interpersonal skills. - Ability to work independently and manage multiple priorities effectively. - Proficiency in electronic medical record (EMR) systems and claims management software. - Commitment to continuous professional development and improvement. Requirements - Registered Nurse (RN) license in California is required. - Minimum of 3 years of clinical nursing experience, preferably in a hospital or healthcare setting. - Experience in medical claims review or utilization management is a plus. - Strong analytical skills with attention to detail and accuracy. - Excellent communication and interpersonal skills. - Ability to work independently and manage multiple priorities effectively. - Proficiency in electronic medical record (EMR) systems and claims management software. - Commitment to continuous professional development and improvement. Benefits - 401(k) - 401(k) matching - Company parties - Dental insurance - Employee discounts - Health insurance - Opportunity for advancement - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources Company Description MedPOINT Management has been a leader in the healthcare management industry for over a decade. Our commitment to excellence and patient-centered care has earned us the trust of our clients and the loyalty of our employees. Join us and be part of a team that makes a difference in the lives of patients every day.

Role Description Under the direction of the VP of Claims and Hospital Operations, the Client Account Manager will serve as a strategic liaison between clients, healthcare providers, hospitals, and internal teams. This role is responsible for ensuring exceptional service delivery, resolving operational challenges, and strengthening client partnerships to support organizational success. The ideal candidate thrives in a fast-paced healthcare environment, excels at cross-functional collaboration, and has a strong understanding of managed care operations, compliance, and client relationship management. Duties and Responsibilities - Serves as the primary point of contact between client stakeholders, providers, hospitals, and internal teams to ensure seamless communication and issue resolution. - Lead client meetings, facilitate discussions, and translate priorities into actionable deliverables. - Build and maintain strong, trusted relationships with clients and other departments by proactively addressing needs and delivering exceptional service. - Manage and resolve escalated contractual, operational, and payment-related issues with a solutions-focused approach. - Conduct root cause analysis to identify trends, improve workflows, and prevent recurring concerns. - Monitor account performance metrics and prepare reports to evaluate service effectiveness and identify areas for improvement. - Track action items, project milestones, and ensure timely completion of deliverables. - Analyze utilization trends, operational data, fraud/waste indicators, and performance outcomes to support informed decision-making. - Partner with Health Plan representatives to resolve service concerns and implement special projects. - Assist with training materials, documentation, and process standardization efforts. - Take ownership of additional responsibilities and special assignments as needed. Qualifications - Minimum 3 years of experience in account management, client services, operations, project management, customer success, or related business functions. Healthcare, managed care, health plans, or related healthcare operations experience is preferred. - Demonstrated experience managing client relationships and resolving complex operational issues. - Proficiency in EZ-CAP, Tableau, Smartsheet preferred. - Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, OneNote). Requirements - Strong analytical and reporting capabilities. - Strong relationship-building and stakeholder management abilities. - Critical thinking and problem-solving mindset. - Demonstrate professionalism while engaging with stakeholders and partners. - Highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced environment. - Lead projects beyond standard job duties and develop training materials. - Understand business needs and MSO Operations. - Manage multiple priorities and deadlines with strong follow-through. - Knowledge of payer operations, contract language, and DOFR interpretation preferred. Benefits - 401(k) - 401(k) matching - Company parties - 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 Company Description MedPOINT Management has been a leader in healthcare management services for over a decade, dedicated to improving patient outcomes and streamlining operations for our clients. Our team is passionate about making a difference, and we pride ourselves on fostering a collaborative and supportive work environment that empowers our employees to thrive. This is a remote position.

Role Description Join MedPOINT Management as an After-Hours Inpatient Coordinator, where you will play a vital role in ensuring seamless patient care during evening and weekend shifts. This position is perfect for those who thrive in a dynamic healthcare environment and are passionate about supporting patients and their families. - Coordinate inpatient admissions and discharges after regular business hours. - Serve as the primary point of contact for hospital staff and patients during after-hours. - Manage patient records and ensure accurate documentation. - Assist with patient inquiries and concerns promptly and professionally. - Collaborate with healthcare providers to facilitate efficient patient care. - Monitor and respond to emergency situations as they arise. - Ensure compliance with healthcare regulations and policies. - Provide support to families and caregivers during critical times. Qualifications - Previous experience in a healthcare coordination role preferred. - Strong communication and interpersonal skills. - Ability to work independently and make sound decisions under pressure. - Familiarity with medical terminology and patient care processes. - Proficient in using electronic health record (EHR) systems. - Availability to work evenings, weekends, and holidays as needed. - Compassionate demeanor with a focus on patient-centered care. - Certification in healthcare administration or related field is a plus. Benefits - 401(k) - 401(k) matching - Company parties - Dental insurance - Employee discounts - Health insurance - Opportunity for advancement - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources Company Description MedPOINT Management has been a leader in healthcare management for over a decade, dedicated to providing high-quality patient care and support. Our team is passionate about making a difference in the lives of our patients and is committed to fostering a positive and collaborative work environment. This is a remote position.

Role Description Join MedPOINT Management as a Credentialing Specialist, Internal Auditor, where you'll play a vital role in ensuring compliance and accuracy in our credentialing processes. This dynamic position is perfect for detail-oriented professionals looking to contribute to a leading healthcare management company in Sherman Oaks, CA. Responsibilities: - Conduct thorough internal audits of credentialing files to ensure compliance with regulatory standards. - Review and verify the credentials of healthcare providers and facilities. - Maintain accurate and up-to-date records in the credentialing database. - Collaborate with cross-functional teams to streamline the credentialing process. - Identify areas for improvement and recommend solutions to enhance operational efficiency. - Prepare detailed reports on audit findings and present to management. - Assist in training staff on credentialing policies and procedures. - Stay current with industry trends and regulatory changes affecting credentialing. Qualifications - Bachelor's degree in healthcare administration, business, or related field. - 2+ years of experience in credentialing or auditing within the healthcare industry. - Strong understanding of credentialing standards and regulatory requirements. - Excellent attention to detail and organizational skills. - Proficient in Microsoft Office Suite and credentialing software. - Ability to work independently and manage multiple tasks effectively. - Strong communication skills, both written and verbal. - Professional certification in credentialing (CPCS or CPMSM) is a plus. Requirements - Bachelor's degree in healthcare administration, business, or related field. - 2+ years of experience in credentialing or auditing within the healthcare industry. - Strong understanding of credentialing standards and regulatory requirements. - Excellent attention to detail and organizational skills. - Proficient in Microsoft Office Suite and credentialing software. - Ability to work independently and manage multiple tasks effectively. - Strong communication skills, both written and verbal. - Professional certification in credentialing (CPCS or CPMSM) is a plus. Benefits - 401(k) - 401(k) matching - Company parties - 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 Company Description MedPOINT Management has been a trusted partner in healthcare management for over a decade, providing exceptional services to our clients. Our commitment to quality and compliance has earned us a reputation for excellence, making us a favorite among healthcare providers and employees alike. Join our team and be part of a supportive work environment that values your growth and contributions. This is a remote position.

Role Description Join MedPOINT Management as an Inpatient UM Coordinator in Sherman Oaks, CA, where you will play a vital role in ensuring quality patient care and efficient utilization management. This position offers an exciting opportunity to work in a dynamic environment focused on improving healthcare outcomes. Responsibilities: - Conduct comprehensive reviews of inpatient cases to determine medical necessity and appropriateness of care. - Collaborate with healthcare teams to develop and implement effective treatment plans. - Monitor patient progress and adjust care plans as needed to ensure optimal outcomes. - Communicate effectively with physicians, nursing staff, and other stakeholders regarding utilization management processes. - Maintain accurate documentation of all case reviews and decisions in compliance with regulatory standards. - Participate in interdisciplinary team meetings to discuss patient care and resource utilization. - Stay updated on industry trends and best practices in utilization management. - Assist in the development and implementation of quality improvement initiatives. Qualifications - Active RN or LPN license in California is required. - Minimum of 3 years of experience in inpatient care or utilization management. - Strong knowledge of medical terminology, coding, and reimbursement methodologies. - Excellent communication and interpersonal skills for effective collaboration. - Proficient in electronic health records (EHR) and utilization management software. - Detail-oriented with strong analytical and problem-solving abilities. - Ability to work independently and manage multiple priorities in a fast-paced environment. - Certification in Utilization Review (CPUR or equivalent) is a plus. Benefits - 401(k) - 401(k) matching - Company parties - Employee discounts - Free food & snacks - Health insurance - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources Company Description MedPOINT Management has been at the forefront of healthcare management for over 15 years, dedicated to enhancing patient care through innovative solutions. Our clients appreciate our commitment to quality service, while our employees thrive in a supportive and collaborative work environment that fosters professional growth.

Role Description Join MedPOINT Management as an Outpatient Data Entry Clerk, where you will play a crucial role in maintaining accurate patient records and supporting our healthcare team. This is an exciting opportunity to contribute to a company dedicated to improving patient care through efficient data management. Responsibilities: - Accurately enter and maintain patient data in the electronic health record system. - Verify and update existing patient information to ensure data integrity. - Assist in the preparation of reports and data summaries for clinical staff. - Respond to data inquiries from healthcare professionals and administrative staff. - Collaborate with team members to optimize data entry processes. - Ensure compliance with HIPAA regulations and data security protocols. - Participate in training sessions to enhance data management skills. - Support additional administrative tasks as needed to ensure smooth operations. Qualifications - High school diploma or equivalent; associate degree preferred. - Proven experience in data entry or administrative support, preferably in healthcare. - Strong attention to detail and accuracy in data handling. - Proficient in Microsoft Office Suite and electronic health record systems. - Excellent organizational and time-management skills. - Ability to work independently and as part of a team. - Strong communication skills, both written and verbal. - Commitment to maintaining patient confidentiality and data security. Requirements - High school diploma or equivalent; associate degree preferred. - Proven experience in data entry or administrative support, preferably in healthcare. - Strong attention to detail and accuracy in data handling. - Proficient in Microsoft Office Suite and electronic health record systems. - Excellent organizational and time-management skills. - Ability to work independently and as part of a team. - Strong communication skills, both written and verbal. - Commitment to maintaining patient confidentiality and data security. Benefits - 401(k) - 401(k) matching - 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