Claims Examiner

Johns Hopkins Medical Management Corporation•Hanover, MD

22h•Remote

About The Position

Johns Hopkins Health System is hiring a Claims Examiner through Johns Hopkins Intrastaff, which connects professionals with flexible temporary opportunities across clinical, allied health, administrative, IT, and other fields. This is a 100% remote position. Candidates must maintain permanent residence in Maryland, Pennsylvania, Virginia, Delaware, Washington, D.C., or Florida. Department-provided equipment is available, and in-home internet is required. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. The pay rate is $24 per hour. The Claims Examiner receives, analyzes, investigates, and adjudicates medical claims submitted on paper or through EDI. The role processes claims and basic payments or denials in accordance with coverage and billing guidelines, researches and verifies claim information, and maintains accurate claim records and timely turnaround. The examiner works with providers, members, vendors, and internal departments to resolve claims issues. Johns Hopkins Health System and its affiliates are Equal Opportunity / Affirmative Action employers. Qualified applicants receive consideration without regard to legally protected status.

Requirements

High school diploma or equivalent.
At least 1–2 years of experience as a medical claim examiner, processing UB and HCFA claims.
Thorough knowledge and understanding of medical terminology, CPT, ICD-9 codes, and claims processing.
Extensive analytical skills to work across multiple claim types.
Working knowledge of subrogation, reinsurance, and coordination of benefits claims.
Permanent residence in Maryland, Pennsylvania, Virginia, Delaware, Washington, D.C., or Florida.
In-home internet is required.

Responsibilities

Receive medical claim requests submitted by paper or EDI for review.
Analyze, investigate, and adjudicate claims across multiple claim types.
Process medical claims using knowledge of medical terminology, CPT, ICD-9 codes, and standard billing guidelines.
Process basic payments and/or claim denials for group health, including Medicaid benefits.
Approve, pend, or deny payment according to accepted coverage guidelines.
Research claims and ensure information is accurate and complete.
Contact insured individuals or other involved parties to obtain missing or additional information.
Update claim files with claim status, questions, or payment information.
Work with providers, members, vendors, and internal departments to address claims issues.
Organize and prioritize work to maintain turnaround time.