Medical Claims Examiners

Healthcare Support Staffing; Annapolis (MD); On-site; USD 24,796 - 30,307; Full time

Benefits offered by this job

Competitive hourly pay above regional average

Professional growth potential

Networking opportunities in insurance claims field

Job summary

Healthcare Support Staffing is seeking an experienced Medical Claims Adjuster in Annapolis, MD, for a rewarding career opportunity. The ideal candidate will bring expertise in processing physician and hospital claims, along with a solid understanding of PPO plans.

This role requires knowledge of ICD-10 and various coding schemes, with a focus on accuracy in claims adjudication. Competitive hourly pay ranging from $18 to $22 based on experience is offered, alongside professional growth potential within a leading national healthcare company.

Qualifications

• Must have a verifiable high school diploma or GED.
• Able to pass a national background check and 10-panel drug test.
• 1+ years of experience in processing managed care medical claims.

Responsibilities

• Ensure accurate and timely adjudication of claims.
• Review providers' disputes and appeals for claims.
• Adhere to state and federal policies when adjudicating claims.

Skills

Knowledge of medical terminology

ICD-9-CM, CPT, HCPCS coding schemes

Data input accuracy

1+ years of processing managed care medical claims

Education

High school diploma or GED

Tools

Claims adjudication software

Job description

Job Description

Are you an experienced Medical Claims Adjuster in the Annapolis, MD area seeking a great career opportunity? Have you recently been looking for prestigious, national healthcare companies to further your long-term goals? Are you seeking real advancement opportunities in-house with a Fortune 500 company? If you answered “yes” to any of these questions – then this opportunity may be for you!

Preference will go to candidates who have current or previous experience from CareFirst, BlueCross, or other major insurance payor companies. We are looking for employees that understand PPO plans and have worked on the commercial line of business. Knowledge of processing physician claims, hospital claims, and ICD-10 is required.

Daily Responsibilities:

Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements, policies and procedures, and generally accepted business practices. Reviews providers' disputes and appeals for professional and hospital claims to determine resolution according to policies and procedures. Adheres to state and federal policies and procedures when adjudicating claims, including but not limited to interest calculation and resolution timeliness.

Pay: $18-22/hr (solely based on experience; higher pay may be considered)

Advantages of this Opportunity:

• Competitive hourly pay above regional average!
• Long-term stability and individual professional growth potential from a national healthcare company that continues to grow!
• You will have the opportunity to add great experience to your resume, while getting the chance to network with several future colleagues in a highly competitive insurance claims field.

Qualifications

• Verifiable high school diploma or GED
• Ability to pass a national background check and 10-panel drug test
• 1+ years of processing managed care medical claims
• Knowledge of medical terminology
• Working knowledge of ICD-9-CM, CPT, HCPCS, RBRVS coding schemes
• Experience with different software and hardware systems for claims adjudication
• Accurate input of data for claims adjudication including diagnostic and procedural coding, pricing schedules, member and provider identification, etc.