Job Description

Summary:

The Medical Claims Processor is responsible for the accurate and timely adjudication of all electronic and paper medical claims according to the Family Medical Care Plan benefit plan provisions and guidelines.

Responsibilities:

• Follow benefit plan documents and established departmental policies and procedures to adjudicate claims within policy provisions
• Determine whether to pay, deny, or pend claims within policy guidelines and adjudicate claims accordingly -processer must be able to review and research claims by navigating multiple computer programs and accurately selecting the data/information necessary for processing (e.g. applicable benefits, coding, priorauthorizations)
• Obtain and maintain a working knowledge of the multiple benefit schedules, as well as a clear understanding of the eligibility system and claim system
• Other duties as assigned

Requirements:

• Minimum 1 year processing medical claims is required, 2 years preferred
• Bachelor’s Degree or equivalent experience required
• Must have a thorough working knowledge of commonly used claims examination concepts, practices and rules, ICD and CPT/revenue coding and network contracts Must have a thorough working knowledge of medical terminology
• Must have a fundamental knowledge of coordination of benefits, including Medicare claims
• Must be able to type 40 wpm
• Dependability – ensures timely arrival and consistent attendance to support the achievement of the team goals
• Excellent written & verbal communication skills Proficiency in MS Office is required Reviewed 11/2023
• Excellent time management skills and ability to multi-task and prioritize work
• Strong attention to detail and problem solving skills
• Strong organizational and planning skills
• Demonstrates ability to manage complex issues while maintaining a flexible, positive, and cooperative demeanor
• Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
• Troubleshoots assigned issues, gathers evidence and investigates all relevant information with vendors and internal departments to resolve the problem in a cooperative and collaborative mannerMedical Claims Processor

$22-25/hr

Rockville, MD

Onsite - hybrid possibility after 6 months

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