Claims Clerk 1

Bakersfield Family Medical Group•Bakersfield, CA

About The Position

Under the direction of the Claims Operation Supervisor, this position is responsible to perform clerical functions in accordance with internal guidelines. The Claims Clerk will interact with other departments, clinical personnel, patients and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

Requirements

High school diploma/certificate required.
Must be able to communicate effectively, both written and verbal.
Ability to organize and prioritize workload and multi-task.
Proven ability to work with all matters of a confidential nature.
Ability to use correct punctuation, grammar and spelling.
Working knowledge and proficiency with Microsoft Office applications (Word, Excel, Outlook, etc.)

Nice To Haves

Prior experience in the health care field preferred.

Responsibilities

Fax and manually send Medical Records requests to providers (MEDREC'S).
Distribute and/or work daily correspondence and reject reports.
Update and maintain Sun Knowledge unidentified members and providers log.
Send manual letters to providers for claims that cannot be entered into the system.
Review and send member and provider denial letters daily.
Review claims that the data entry vendor does not data enter to determine if they should be entered or if they need to be sent back to the provider for corrected information.
Handle claims forwarded by processor needing to be mailed.
Review Senior claim receive date report for date validation.
Research correspondence and process appropriately.
Data Entry of claims as needed.
Acknowledge PDRs routed by Claims Clerk 2.
Perform other duties as assigned.