MEDICAL CLAIMS REVIEW CLERK
Medical Claims Review Clerk is a competitive state or local title, the kind you test for: the exam result, not a hiring manager's pick, decides where you land in line.
What it takes is 3 years of relevant experience. Pay on the FY 2027 schedule runs $39,358 to $56,481.
How to apply
This title is filled by competitive examination.
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See where to apply for this title →Where this title is used
Medical Claims Review Clerk is a common title, so it is used in both State and local service. The local side is filled by the counties, municipalities, authorities and other employers that have adopted civil service under Title 11A, which set their own pay by ordinance or contract rather than from a State salary schedule.
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Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under the supervision of a supervisory officer in the Division of Medical Assistance and Health Services, Department of Human Services, or in a local government agency or institution, reviews and audits medical claims to ensure compliance with the policies, procedures, and allowances of the New Jersey Medical Assistance Programs; does other related duties.
Examples of work
- Makes determinations, based on established rules and policies, with advice from professional consultants.
- Reviews claims to verify eligibility and accuracy of arithmetical calculations.
- Receives and reviews claims and prior authorization requests to determine adherence to policies and procedures.
- Reviews claims and authorization requests to determine compliance with schedule of allowances.
- Consults with supervisor regarding the disposition and/or processing of irregular or incomplete claims and authorization requests.
- Maintains a roster of professional persons who are approved to provide specialized medical services.
- Collects and maintains data for reports.
- Makes corrections and adjustments to work.
- Prepares and types letters.
- Prepares summaries and reports based on information and records.
- Maintains records and files.
- Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
Experience
Three (3) years of clerical experience involving auditing and/or accounting work, some of which shall have included the application of medical terminology.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform essential duties of the position.
Knowledge, skills and abilities
- Knowledge of business office methods, procedures and routines and their application to clerical claims review and audit work.
- Knowledge of the rules, regulations, policies and procedures of the Division and their application to specific cases.
- Knowledge of office routines and practices and their application to specific situations.
- Ability to operate calculators, typewriters, fax machines, copiers, personal computers, and other office equipment.
- Ability to prepare and type reports and communications.
- Ability to apply the established policies and procedures of a detailed medical program.
- Ability to use medical terminology.
- Ability to assign and instruct clerical employees of the unit and supervise the performance of their work.
- Ability to make and check arithmetic calculations.
- Ability to supervise the checking of medical claims for payment.
- Ability to prepare reports and summaries based upon information and records maintained.
- Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
- Ability to read, write, speak, understand, and communicate in English sufficiently to perform duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
- Persons with mental or physical disabilities are eligible as long as they can perform essential functions of the job with or without reasonable accommodation. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.