Medicaid & Medicare Claims Adjudicator

FLORIDA PACE CENTERS, INC.; Bayshore (FL); On-site; USD 42,000 - 56,000; Full time

Job summary

Miami Jewish Health is seeking a Claims Adjudicator to adjudicate medical and non-medical provider claims and submit enrollments/disenrollment to Florida Medicaid and CMS. You will support revenue/expense processes, manage rate tables, and ensure accurate capitation reimbursement.

The role requires at least two years of claims adjudication experience, strong Windows/Office skills, and the ability to work independently in a busy health system environment.

Qualifications

• Proven experience in claims adjudication or similar roles.
• Ability to adjudicate medical and non-medical provider claims.
• Experience processing enrollments/disenrollments with Medicaid/Medicare.

Responsibilities

• Adjudicate medical and non-medical claims as required.
• Verify referrals/authorizations and enter provider data.
• Generate remittance notices and manage check requests.
• Work with IT to obtain/load rate data and batch transmissions.
• Prepare monthly expense accruals for multiple service lines.
• Support enrollment/disenrollment review meetings and processes.
• Maintain accuracy in client eligibility and capitation reimbursement.

Skills

Windows OS

Microsoft Outlook

Excel

Word

Organizational skills

Interpersonal communication

Education

High School Diploma

Associates Degree Preferred

Tools

Medicare/Medicaid Claims Systems

Job description

Miami Jewish Health is seeking a Claims Adjudicator to adjudicate medical and non-medical provider claims and submit enrollments/disenrollment to Florida Medicaid and CMS. You will support revenue/expense processes, manage rate tables, and ensure accurate capitation reimbursement.

The role requires at least two years of claims adjudication experience, strong Windows/Office skills, and the ability to work independently in a busy health system environment.