Kern Family Health Care
TEMP Claims Examiner I
Kern Family Health Care, Bakersfield, California, United States, 93399
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
About the role Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures. This position is responsible for claims auditing and payment functions for a Knox-Keene licensed health maintenance organization (HMO).
Essential Duties and Responsibilities Resolve system suspended claims for:
PCPs
Labs
Radiology
Less complicated specialists
Physical Therapy
Deny inappropriate claims following policy guidelines.
Prepare claims that must be routed to other departments for further review.
Review difficult claims with guidance from Claims Supervisor.
Identify billing errors and possible fraudulent claim submissions.
Obtain eligibility verification and other health insurance coverage by Internet or POS.
Perform correct manual calculation of benefits when applicable.
Identify possible CCS eligible claims for further investigation.
Report overpayment refund requests on SharePoint log.
Maintain productivity and quality in accordance with established guideline.
Perform other job-related duties as required.
Adhere to all company policies and procedures relative to employment and job responsibilities.
Employment Standards High School Diploma from an accredited school or equivalent.
Minimum of one (1) year medical Claims Examiner processing experience.
Individual must have good organizational skills and the ability to make good decisions.
Knowledge of Computerized on-line data entry systems; organizational structure of medical claims processing; medical terminology; HCPCS, CPT & ICD-10 coding, UB04 and CMS1500 forms.
Ability to Adapt to a rapidly evolving work environment; work independently; communicate with a variety of personnel and providers.
Seniority level Entry level
Employment type Temporary
Job function Customer Service
Hospitals and Health Care and Insurance
Salary: Bakersfield, CA $72,700.00-$96,800.00
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About the role Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures. This position is responsible for claims auditing and payment functions for a Knox-Keene licensed health maintenance organization (HMO).
Essential Duties and Responsibilities Resolve system suspended claims for:
PCPs
Labs
Radiology
Less complicated specialists
Physical Therapy
Deny inappropriate claims following policy guidelines.
Prepare claims that must be routed to other departments for further review.
Review difficult claims with guidance from Claims Supervisor.
Identify billing errors and possible fraudulent claim submissions.
Obtain eligibility verification and other health insurance coverage by Internet or POS.
Perform correct manual calculation of benefits when applicable.
Identify possible CCS eligible claims for further investigation.
Report overpayment refund requests on SharePoint log.
Maintain productivity and quality in accordance with established guideline.
Perform other job-related duties as required.
Adhere to all company policies and procedures relative to employment and job responsibilities.
Employment Standards High School Diploma from an accredited school or equivalent.
Minimum of one (1) year medical Claims Examiner processing experience.
Individual must have good organizational skills and the ability to make good decisions.
Knowledge of Computerized on-line data entry systems; organizational structure of medical claims processing; medical terminology; HCPCS, CPT & ICD-10 coding, UB04 and CMS1500 forms.
Ability to Adapt to a rapidly evolving work environment; work independently; communicate with a variety of personnel and providers.
Seniority level Entry level
Employment type Temporary
Job function Customer Service
Hospitals and Health Care and Insurance
Salary: Bakersfield, CA $72,700.00-$96,800.00
#J-18808-Ljbffr