Top 68 Medical claims processing Jobs in Columbia Md

Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $23.56 an hour
- Microsoft Excel
- Microsoft Outlook
- Customer service
Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $24.13 an hour
- Microsoft Excel
- Microsoft Outlook
- Customer service
Revenue Cycle Denial Specialist
United Theranostics —Bethesda, MD
- $27 - $30 an hour
- Full-time
- Writing skills
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
1d
Team Support Assistant - Physicians' Billing
MedStar Health —Baltimore, MD
- $18.40 - $29.74 an hour
- Full-time
- Hybrid work
- Office
- Windows
- Administrative experience
3d
Medical Biller
Drs Siekanowicz & Gowda LLC —Silver Spring, MD
- $27 an hour
- Full-time
- HIPAA
- Entry level
Medical Biller
Healthy Mind Foundation Limited —Baltimore, MD
- $4,000 a month
- Full-time
- Organizational skills
- Entry level
- Opportunities for advancement
Quick Apply
Accounts Receivable Rep I, Hybrid
University of Maryland Medical System —Linthicum Heights, MD
- $19.50 - $27.31 an hour
- Full-time
- Microsoft Access
- Customer service
- Computer literacy
Pharmacy Technician - Refill Calls
Shields Health Solutions —Baltimore, MD
- $19 - $22 an hour
- Overtime
- Remote
- Microsoft Outlook
- High school diploma or GED
- Communication skills
- Paid parental leave
- Paid holidays
Quick Apply
Accounts Receivable Rep- 3rd Party Non-Gov't payers
TridentCare —Sparks, MD
- $0.01 - $999.00 an hour
- Remote
- Computer literacy
- High school diploma or GED
- Analysis skills
- Paid holidays
- Disability insurance
Quick Apply
Medical Biller
Potomac Pediatrics PC —Rockville, MD
- $23 - $30 an hour
- Part-time
- Mid-level
- Office
- In-person
Quick Apply
Medicare Analyst
Barrow Wise Consulting —Rockville, MD
- $70,000 - $90,000 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- Senior level
- Health insurance
- 401(k)
Quick Apply
PT Accounts Receivable Rep I, Hybrid
University of Maryland Medical System —Linthicum Heights, MD
- $19.50 - $27.31 an hour
- Full-time
- Microsoft Access
- Customer service
- Computer literacy
Pt Accts Rec Rep II, Hybrid
University of Maryland Medical System —Linthicum Heights, MD
- $21.50 - $30.12 an hour
- 12 hour shift
- Microsoft Access
- Research
- Mid-level
Billing and Collections Supervisor - Hybrid
Sheppard Pratt —Towson, MD
- $58,401.82 - $90,195.04 a year
- Mid-level
- Business Administration
- Business
- 403(b) matching
- Mileage reimbursement
Quick Apply
Medicare/Medicaid Revenue Cycle Manager
Barrow Wise Consulting —Rockville, MD
- $90,000 - $150,000 a year
- Full-time
- Remote
- 7 years
- Bachelor's degree
- Mentoring
- Health insurance
- 401(k)
Quick Apply
Senior Medical Coding Specialist (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,464 - $133,991 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Presentation skills
- 401(k)
Quick Apply
Dental/Medical Biller
Anne Arundel County Health Department —Annapolis, MD
- $29 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Contracts
- Paid holidays
- Health insurance
Billing Specialist
Community Clinic Inc. —Silver Spring, MD
- $25 - $30 an hour
- Full-time
- Computer literacy
- Bachelor of Science
- HIPAA
- Tuition reimbursement
- Paid time off
Quick Apply
Medical Billing Specialist
All Day Medical Care Clinic —Gaithersburg, MD
- $30.08 - $35.20 an hour
- Part-time
- Microsoft Excel
- Customer service
- Mid-level
- Relocation assistance
- Dental insurance
Quick Apply
1d
Risk Adjustment Coding Specialist (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $51,984 - $95,304 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- 401(k)
Quick Apply

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medical claims processing jobs near columbia md

Referral Management (Non-Nurse) Reviewer

Zimmerman Associates, Inc. -
Bethesda, MD

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Job Details

$23.56 an hour

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Customer service
Associate's degree
Medical terminology

Full Job Description

Zimmerman Associates, Inc. (ZAI) is seeking to hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region’s premier authority for appointment coordination and referral management services for beneficiaries within the Defense Health Network.

Pay Rate: $23.56 per hour plus $4.93 Health & Wellness Fringe

Role and Responsibilities:

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty referrals for Active-Duty Service Members and TRICARE Prime beneficiaries enrolled at Military Treatment Facilities (MTFs) within the National Capital Region.

This is an onsite opportunity

Qualifications / Skills / Experience:

Minimum of an Associate’s degree
At least 2 years of experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral
U.S. Citizenship required, with the ability to obtain a Public Trust Clearance
Knowledge of medical care criteria such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs), or other evidence-based Military Health System (MHS) guidelines
Familiarity with medical terminology and ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information protocols
Excellent communication and interpersonal skills
Strong customer service orientation
Understanding of Access to Care Standards within the Direct Care System
Attention to detail, including correct use of deferral codes
Strong organizational skills with ability to prioritize tasks and manage time effectively
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook) and internet navigation

Essential Tasks:

Review and process referrals for administrative and clinical completeness and appropriateness, completing disposition within 24 hours of referral date
Collaborate with appointing centers, case managers, product line nurses, providers, clinics, managed care contractors, and other healthcare team members to ensure appropriate use of Direct Care and civilian network resources
Ensure patients are scheduled with the right provider, at the right time and place
Review compliance with Specialty Referral Guidelines (SRGs) per IRMAC protocols
Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required Return of Favorable Response (ROFR) timelines
Manage telephone, written, and electronic communications regarding specialty appointments and referrals
Monitor and process referral management worklists (e.g., Genesis Work Lists) to ensure timely consult processing
Communicate referral status to patients, including benefit counseling and advocacy resources as needed
Reschedule or redirect patients within 3 days when referrals are disapproved or invalid, advising on other care options and Line-of-Duty issues
Receive and enter ROFR referrals in MHS-GENESIS from Military Contractor Support Centers (MCSC) portals for assigned specialties/product lines, adhering to all timelines and business rules
Verify patient eligibility and update demographics in MHS-GENESIS
Document patient interactions, especially when appointments are refused, and coordinate with Beneficiary Counselor and Assistance Coordinator as appropriate
Coordinate with product line nurses and clinics for special accommodations
Interface with MCSC and multidisciplinary teams to ensure referral appropriateness
Submit referrals to non-network providers for TRICARE Service Center medical necessity reviews
Monitor referral management voicemail and return patient calls within established guidelines
Provide External Provider Referral Online (EPRO) information as requested
Close unused referrals following DHA IPM and NCR Medical Directorate policies, notifying ordering providers accordingly
Orient and train new IRMAC staff on referral processes and timelines
Perform other duties as assigned

Zimmerman Associates, Inc. is an equal opportunity employer. We comply with Federal and State Equal Opportunity laws and consider qualified applicants without regard to race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status, or any other protected status.

#INDSPN

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Refine Your Search

medical claims processing jobs in columbia md

Referral Management (Non-Nurse) Reviewer

Referral Management (Non-Nurse) Reviewer

Revenue Cycle Denial Specialist

Team Support Assistant - Physicians' Billing

Medical Biller

Medical Biller

Accounts Receivable Rep I, Hybrid

Pharmacy Technician - Refill Calls

Accounts Receivable Rep- 3rd Party Non-Gov't payers

Medical Biller

Medicare Analyst

PT Accounts Receivable Rep I, Hybrid

Pt Accts Rec Rep II, Hybrid

Billing and Collections Supervisor - Hybrid

Medicare/Medicaid Revenue Cycle Manager

Senior Medical Coding Specialist (Remote)

Dental/Medical Biller

Billing Specialist

Medical Billing Specialist

Risk Adjustment Coding Specialist (Hybrid)

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