Adjustment Clerk jobs in Baltimore, MD

Adjustment Clerk reviews and follows up on customer complaints regarding account balances and uncredited items. Analyzes associated documents and makes necessary adjustments to accounts and/or recommendations to resolve customer issues. Being an Adjustment Clerk communicates results of findings to customer. Requires a high school diploma or its equivalent. Additionally, Adjustment Clerk typically reports to a supervisor or manager. The Adjustment Clerk possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)

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Risk adjustment and
  • CareFirst BlueCross BlueShield
  • Baltimore, MD FULL_TIME
  • Resp & Qualifications

    PURPOSE :

    We are looking for an experienced professional to live and work remotely from within the greater Baltimore / Washington metropolitan area.

    The incumbent will be expected to come into a CareFirst location periodically for meetings, training and / or other business-related activities.

    Acts as an internal population health expert to engage members to drive improvement in NCQA HEDIS measure performance. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and all chronic conditions are captured at the highest level of specificity to ensure Risk Adjustment Revenue is accurate and reflective of true managed care needs.

    Utilizes extensive HEDIS and coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes and STARs outcomes while not compromising payment integrity.

    Note : We are looking for an experience professional who is willing and able to work onsite with health care system partners in the greater Baltimore metropolitan area as an embedded team member.

    In addition, the incumbent will be expected to come into a CareFirst location periodically for meetings, trainings, and / or other business-related activities.

    ESSENTIAL FUNCTIONS :

    Conducts member outreach for appointment scheduling and collaborates with provider to ensure closure of quality and risk adjustment gaps in care.

    Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes.

    Supports to use of alternatives and solutions to maximize quality payments and risk adjustment.

    • Fulfill various requests for patient charts and clinical information made by the health plan that are normally handled by the office staff.
    • Serves as a technical resource / coding subject matter expert for contract pricing related issues. Conducts business and operational analyses to assure payments are in compliance with contract;

    identifies areas for improvement and clarification for better operational efficiency. Provides problem solving expertise on systems issues if a code is not accepted.

    Troubleshoots, make recommendations and answer questions on more complex coding and billing issues whether systemic or one-off.

    Supports and contributes to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity.

    Consults with various teams, including the Quality, Risk Adjustment, Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.

    Maintains a repository of information needed for various audits initiated by regulatory bodies. Keeps up-to-date on coding rules and standards.

    QUALIFICATIONS :

    Education Level : High School Diploma or GED.

    • CCS-Certified Coding Specialist.
    • Certified Coder (CCS or CPC)-AHIMA or AAPC.
    • Experience : 3 years experience in risk adjustment coding, ambulatory coding and / or CRC coding experience in managed care;

    state or federal health care programs; or health insurance industry experience.

    Preferred Qualifications :

    • Bachelor's degree in related discipline.
    • Experience in medical auditing.
    • Experience in training / education / presenting to large groups.
    • Experience in revenue cycle management and value-based reimbursement / contracting models and methodologies.
    • Experience communicating with administrators and clinicians in a provider practice. Experience engaging patients and assisting with navigating their health care needs.

    Knowledge, Skills and Abilities (KSAs)

    • Knowledge of billing practices for hospitals, physicians and / or ancillary providers as well as knowledge about contracting and claims processing.
    • Knowledge and understanding of medical terminology to address codes and procedures.
    • Excellent communication skills both written and verbal.
    • Detail oriented with an ability to manage multiple projects simultaneously.
    • Demonstrated ability to effectively analyze and present data.
    • Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and demonstrated ability to learn / adapt to computer-based tracking and data collection tools.
    • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

    Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

    Salary Range : $53,856 - $106,964

    Salary Range Disclaimer

    The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed.

    This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education / training, internal peer equity, and market and business consideration.

    It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

    In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs / plans, and 401k contribution programs / plans (all benefits / incentives are subject to eligibility requirements).

    Department

    Stars

    Equal Employment Opportunity

    CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

    Where To Apply

    Please visit our website to apply : www.carefirst.com / careers

    Federal Disc / Physical Demand

    Note : The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him / her ineligible to perform work directly or indirectly on Federal health care programs.

    PHYSICAL DEMANDS :

    The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required.

    The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear.

    Weights up to 25 pounds are occasionally lifted.

    Sponsorship in US

    Must be eligible to work in the U.S. without Sponsorship

    LI-CT1

    PDN-9b3a7a3e-84e0-40f3-aec9-560db0d803e7

    Last updated : 2024-02-27

  • 27 Days Ago

C
Risk adjustment specialist
  • Choptank Community Health System, Inc..
  • Denton, MD FULL_TIME
  • Job Description Job Description Risk Adjustment Coding Integrity SpecialistAre you looking for meaningful, rewarding work that provides access to exceptional, comprehensive, and integrated health care...
  • 20 Days Ago

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Manager, Medicare Risk Adjustment
  • Johns Hopkins Medicine
  • Hanover, MD FULL_TIME
  • Who you are: As the Manager of Medicare Risk Adjustment for the Johns Hopkins’ Medicare Advantage plan, you will lead a team of certified coders in performing audits and coding for the HCC as well as ...
  • 4 Days Ago

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Risk Adjustment Coding Specialist
  • Johns Hopkins Medicine
  • Hanover, MD 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 ...
  • 16 Days Ago

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Writer remote
  • Metro Public Adjustment
  • Baltimore, MD FULL_TIME
  • Job Description : The position we are hiring for is customer / client relations. In this position you will be writing claims and submitting the paperwork. Our mission is to educate and protect propert...
  • 19 Days Ago

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Public Adjuster
  • Metro Public Adjustment
  • Timonium, MD FULL_TIME
  • Public Adjuster (It’s Very Simple)This is for real!You’ve been waiting for this all your life!!!!!Fire Your Boss!!You Owe It To Yourself Commission basedWe will train the right peoplePart time $35,000...
  • 20 Days Ago

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0 Adjustment Clerk jobs found in Baltimore, MD area

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Claims Adjuster
  • Sedgwick
  • Baltimore, MD
  • Claims Adjuster page is loaded **Claims Adjuster** **Claims Adjuster** locationsBaltimore, MD posted onPosted Yesterday ...
  • 3/28/2024 12:00:00 AM

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Adjuster Assistant
  • Riggs Counselman Michaels & Downes Inc
  • Towson, MD
  • ** Adjuster Assistant** **Job Category****:** SISCO **Requisition Number****:** ADJUS01303 Showing 1 location **Job Deta...
  • 3/28/2024 12:00:00 AM

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Liability Adjuster
  • Erie Insurance Group
  • Silver Spring, MD
  • **Liability Adjuster** **Location:** Silver Spring, MD, US, 20904 **Division or Field Office:** Silver Spring Branch Off...
  • 3/28/2024 12:00:00 AM

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Machine Adjusters
  • Double Envelope
  • Baltimore, MD
  • Job Description Job Description Double Envelope, a leading manufacturer of custom envelopes, has immediate openings in o...
  • 3/28/2024 12:00:00 AM

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Property Adjuster I
  • Erie Insurance Group
  • Baltimore, MD
  • **Location:** Baltimore, MD, US, 21234 **Division or Field Office:** Hagerstown Claims Office **Department of Position:*...
  • 3/27/2024 12:00:00 AM

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Large Loss Property Field Claims Adjuster (Baltimore, MD or Washington DC)
  • American Family Insurance
  • Baltimore, MD
  • At American Family Insurance Claims Services (AFICS, Inc.), we're embarking on a transformation of our claims capabiliti...
  • 3/27/2024 12:00:00 AM

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Claims Adjuster I
  • Marriott International
  • Bethesda, MD
  • Job Description JOB SUMMARY A Claims Adjuster I is responsible for the timely, good faith adjustment and disposition of ...
  • 3/24/2024 12:00:00 AM

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Claims Adjuster, Bodily Injury
  • Tesla Motors
  • Owings Mills, MD
  • The Role Responsible for investigating and confirming the facts of loss for automobile accidents. Applies analytical thi...
  • 3/24/2024 12:00:00 AM

Baltimore (/ˈbɔːltɪmɔːr/) is the largest city in the state of Maryland within the United States. Baltimore was established by the Constitution of Maryland as an independent city in 1729. With a population of 611,648 in 2017, Baltimore is the largest such independent city in the United States. As of 2017[update], the population of the Baltimore metropolitan area was estimated to be just under 2.808 million, making it the 20th largest metropolitan area in the country. Baltimore is located about 40 miles (60 km) northeast of Washington, D.C., making it a principal city in the Washington-Baltimo...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Adjustment Clerk jobs
$33,865 to $42,055
Baltimore, Maryland area prices
were up 1.5% from a year ago

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The title adjustment clerk is given solely for the reason that these individuals provide adjustment in lieu of advice.
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