Medicare/Medicaid Claims Adjudicator

FreshDirect LLC; Bayshore (FL); On-site; USD 42,000 - 66,000; Full time

Job summary

Miami Jewish Health in Miami, FL, seeks a Claims Adjudicator to adjudicate medical and non-medical provider claims and submit enrollments to Florida Medicaid and CMS. This role supports revenue and expense processes, procures rate tables, and ensures accurate capitation reimbursement.

Responsibilities include processing medical/non-medical claims, enrolling/disenrolling clients, preparing accruals, and coordinating with IT for data uploads and with accounting for reimbursements.

Qualifications

• High school diploma or equivalent; associate degree preferred.
• Minimum two years of experience in claims adjudication for community service programs.
• Knowledge of Windows, Outlook, Excel and Word; strong organizational and communication skills.

Responsibilities

• Completes medical and non-medical claims adjudication with accuracy and timeliness.
• Verifies referrals/authorizations and processes enrollments/disenrollments for Medicaid and CMS.
• Coordinates with IT for data uploads and with Accounts Payable for batch claims.
• Prepares and processes monthly revenue and expense accruals for various services.
• Maintains confidentiality and adheres to organizational policies and guidelines.
• Participates in department meetings and supports ongoing process improvements.

Skills

Independent work

Organizational skills

Interpersonal communication

Education

High school diploma or equivalent

Associates Degree preferred

Tools

Windows

Microsoft Outlook

Excel

Word

Job description

Miami Jewish Health in Miami, FL, seeks a Claims Adjudicator to adjudicate medical and non-medical provider claims and submit enrollments to Florida Medicaid and CMS. This role supports revenue and expense processes, procures rate tables, and ensures accurate capitation reimbursement.

Responsibilities include processing medical/non-medical claims, enrolling/disenrolling clients, preparing accruals, and coordinating with IT for data uploads and with accounting for reimbursements.