Medical Claims Processor (FMCP)
Administrative, Office & Clerical
Rockville
,
MD
Contract to Perm
JOB SUMMARY:
The Medical Claims Processor is responsible for the accurate and timely adjudication of all
electronic and paper medical claims according to the Family Medical Care Plan benefit plan provisions and guidelines.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
• Follow benefit plan documents and established departmental policies and procedures to adjudicate claim
within policy provisions
• Determine whether to pay, deny, or pend claims within policy guidelines and adjudicate claims accordingly -
processer must be able to review and research claims by navigating multiple computer programs and
accurately selecting the data/information necessary for processing (e.g. applicable benefits, coding, prior
authorizations)
• Obtain and maintain a working knowledge of the multiple benefit schedules, as well as a clear understanding
of the eligibility system and claim system
• Other duties as assigned
REQUIRED AND PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:
• Minimum 1 year processing medical claims is required, 2 years preferred
• Bachelor’s Degree or equivalent experience required
• Must have a thorough working knowledge of commonly used claims examination concepts, practices and
rules, ICD and CPT/revenue coding and network contracts
• Must have a thorough working knowledge of medical terminology
• Must have fundamental knowledge of coordination of benefits, including for Medicare claims
• Must be able to type 40 wpm
• Dependability – ensures timely arrival and consistent attendance to support the achievement of the team’s
goals
• Excellent written & verbal communication skills
• Proficiency in MS Office is requiredReviewed 11/2023
• Excellent time management skills and ability to multi-task and prioritize work
• Strong attention to detail and problem solving skills
• Strong organizational and planning skills
• Demonstrates ability to manage complex issues while maintaining a flexible, positive, and cooperative
demeanor
• Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
• Troubleshoots assigned issues, gathers evidence, and investigates all relevant information with vendors and
internal departments to resolve the problem in a cooperative and collaborative manner
Medical Claims Processor
$20-25/hr
Rockville, MD
