[Hiring] Claims Examiner @Johns Hopkins Medical Management Corporation

Role Description

Johns Hopkins Health System is hiring for a Claims Examiner.

• Schedule: Monday- Friday, 8:30am-5:00pm
• Location: 100% remote
• Equipment will be provided by department
• In-home internet is required
• Candidates are required to hold permanent residence in one of the following states:
  • Maryland
  • Pennsylvania
  • Virginia
  • Delaware
  • Washington D.C.
  • Florida
• Pay Rate: $24 per hour

Responsibilities:

• Analyze, investigate, and adjudicate medical claims submitted by paper or EDI.
• Process claims and basic payments or denials in accordance with accepted coverage guidelines and standard billing guidelines, supporting accurate claim records and timely turnaround.
• Receive medical claim requests submitted by paper or EDI for review.
• Analyze, investigate, and adjudicate claims across multiple claim types.
• Process medical claims using knowledge of medical terminology, CPT, ICD-9 codes, and standard billing guidelines.
• Process basic payments and/or claim denials for group health, including Medicaid benefits.
• Approve, pend, or deny payment according to accepted coverage guidelines.
• Research claims and ensure information is accurate and complete.
• Contact insured individuals or other involved parties to obtain missing or additional information.
• Update claim files with claim status, questions, or payment information.
• Work with providers, members, vendors, and internal departments to address claims issues.
• Organize and prioritize work to maintain turnaround time.

Qualifications

• High school diploma or equivalent.
• At least 1–2 years of experience as a medical claim examiner, processing UB and HCFA claims.
• Thorough knowledge and understanding of medical terminology, CPT, ICD-9 codes, and claims processing.
• Extensive analytical skills to work across multiple claim types.
• Working knowledge of subrogation, reinsurance, and coordination of benefits claims.

Company Description

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.