Medical Claims Processor

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 provisionsDetermine 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 datainformation 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 systemOther duties as assignedRequirements:Minimum 1 year processing medical claims is required, 2 years preferredBachelor's Degree or equivalent experience requiredMust have a thorough working knowledge of commonly used claims examination concepts, practices and rules, ICD and CPTrevenue coding and network contracts Must have a thorough working knowledge of medical terminologyMust have a fundamental knowledge of coordination of benefits, including Medicare claimsMust be able to type 40 wpmDependability - ensures timely arrival and consistent attendance to support the achievement of the team goalsExcellent written & verbal communication skills Proficiency in MS Office is required Reviewed 112023Excellent time management skills and ability to multi-task and prioritize workStrong attention to detail and problem solving skillsStrong organizational and planning skillsDemonstrates ability to manage complex issues while maintaining a flexible, positive, and cooperative demeanorResponds in a timely manner to operations leaders and stakeholders to facilitate informed decision-makingTroubleshoots 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$22-25hrRockville, MDOnsite - hybrid possibility after 6 months

Created: 2025-02-21