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Job Details

Claims Examiner I

Requisition #: 182110
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Coding
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: May 23, 2019

Johns Hopkins Health System employs more than 20,000 people annually. When joining the Johns Hopkins Health System, you became part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. Great careers continually advance here.

Responsible for the analysis, investigation, and adjudication of medical claims. Receive requests as either paper or EDI for review. Work requires previous knowledge and understanding of processing medical claims, medical terminology in addition to CPT -4, ICD-9-10 codes, HCPCS, ASA, UB92 Codes, and standard billing guidelines.

Duties include but are not limited to processing basic payments and/or claim denials for group health, which includes Medicaid benefits; demonstrating the highest levels of customer service, technical skills, and professionalism to ensure mutually rewarding and continued provider relationships. Approving, pending, or denying payment according to the accepted coverage guidelines.

Maintaining internal customer relations by interacting with various departments regarding claims issues, providing service as key contact for providers or members and working as directed with the vendors, researching, and ensuring accurate and complete claim information. Contacting insured or other involved parties for additional or missing information; updating information to claim file with regard to claims status, questions or claim payments.tion of claims systems.

Requirements:

  1. Education:

High School Diploma or Equivalent.

B. Knowledge:

Work requires thorough knowledge and understanding of medical terminology in addition to CPT and ICD-9-codes.

Requires thorough knowledge and understanding of processing claims and familiarity with on-line claims systems processing preferred.

C. Skills:

Work requires extensive analytical skills to encompass multiple claim types.

Work requires the ability to organize and prioritize work in order to maintain turnaround time. Examiners must be able to communicate effectively and work well with coworkers.

D. Required Licensure, Certification, Etc.:

None

E. Work Experience:

Requires at least one to two years experience as a medical claim examiner, processing UB and HCFA’s and must have a working knowledge of subrogation, reinsurance and coordination of benefits claims.

F. Machines, Tools, Equipment:

Must be able to operate general office and communications equipment.

Pay Grade: NC

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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