Claims Examiner Ii

Responsible for the analysis, investigation, and adjudication of medical claims. Receive requests as either paper or EDI for review. Work requires previous knowledge and understanding of processing medical claims, medical terminology in addition to CPT
-4, ICD-9-10 codes, HCPCS, ASA, UB92 Codes, and standard billing guidelines.

Duties include but are not limited to processing basic payments and/or claim denials for group health, which includes Medicaid benefits; demonstrating the highest levels of customer service, technical skills, and professionalism to ensure mutually rewarding and continued provider relationships. Approving, pending, or denying payment according to the accepted coverage guidelines. Maintaining internal customer relations by interacting with various departments regarding claims issues, providing service as key contact for providers or members and working as directed with the vendors, researching, and ensuring accurate and complete claim information.

Contacting insured or other involved parties for additional or missing information; updating information to claim file with regard to claims status, questions or claim payments.

High School Diploma or Equivalent. Some college a plus.

Work requires an advanced knowledge of medical claims adjudication and policies and procedures adherent to claims processing.
Requires proficient use and understanding of medical terminology generally acquired in a minimum of 3 years of claims experience.

Minimum 17.34/hour - Maximum 28.68/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.