Claims Examiner I

2 days ago

Hanover, United States Johns Hopkins HealthCare Full time

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

  • Work-life balance - This is a remote role. Applicants living in MD, DC, VA, PA, DE, or FL will be given first consideration.
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE
As a Claims Examiner I, you'll:
  • Be 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-10 codes, HCPCS, ASA, UB92 Codes, and standard billing guidelines.
  • Process basic payments and/or claim denials for three separate lines of business
  • Ensure quality claims processing in order to ensure quality service to our members and providers
What you'll bring:
  • One to two years' experience as a medical claim examiner, processing UB and HCFA's or equivalent experience in the medical field in billing or coding of claims or such experience in related healthcare occupations if not direct processing of claims for a payer.
  • Thorough knowledge and understanding of medical terminology in addition to CPT and ICD-10-codes.
  • Knowledge of standard Microsoft office package; data entry skills required
  • High School Diploma or Equivalent. College degree preferred but not required

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Salary Range: Minimum 19.00 per hour - Maximum 26.69 per 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.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins

Diversity and Inclusion are Johns Hopkins Medicine Core Values. 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.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. 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.

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