Claims Examiner II- Bakersfield 1.1
About The Position
The Claims Examiner II adjudicates medical claims in the claims transaction system and verifies that information is accurately captured and complete in the database. The role processes both professional claims (CMS 1500) and institutional claims (CMS 1450/UB04), auditing specific fields as prompted by the system to ensure accuracy and completeness for each claim in a batch. This is a full-time, non-exempt, hourly position based onsite in Bakersfield, California. Universal Healthcare MSO’s standard operating hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time; employees are expected to work their assigned schedules and remain available during these hours unless otherwise specified. The initial pay range is $21.40 to $26.74 per hour, with the offered base pay potentially adjusted based on relevant knowledge, skills, and experience.
Requirements
- High school diploma or equivalent.
- Strong knowledge of professional and institutional claim processing procedures, including COB (Coordination of Benefits), TPL (Third Party Liability), and WC.
- Familiarity with CPT, HCPCS, ICD-10, ASA, Revenue Codes, and related coding systems.
- Ability to perform high-volume data entry.
- Strong background with system automation of claims processes and workflows.
- Familiarity with office equipment, including photocopiers, scanners, and facsimile machines.
- Proficiency in MS Excel, Word, and Outlook.
- Ability to type 40–50 words per minute (WPM) or 6,000–8,000 keystrokes per hour (KSPH).
- One or more years of experience working in a healthcare or other related business environment.
Nice To Haves
- Experience in medical billing services and/or a managed care environment is preferred.
Responsibilities
- Follow written criteria, policies, and procedures to review and process claims thoroughly.
- Evaluate claims for payment appropriateness, considering eligibility, benefits, authorizations, coding, compliance, contracted payment terms or relevant fee schedules, and health plan contracts.
- Stay informed about annual contract changes and apply the correct terms to claims.
- Process denials accurately in the system to facilitate correct letter generation.
- Meet internal, external, and governmental timeliness standards for claims processing.
- Make decisions about payment or denial of medical services while handling sensitive and confidential information discreetly.
- Refer claims and accompanying documentation to the Utilization Management (UM) department when they do not align with department policy guidelines.
- Coordinate with Eligibility, Member Services, UM, providers, Health Plans, and applicable staff as needed to resolve claims.
- Meet established production and quality standards for accurate and efficient claims processing.
- Work independently on assigned tasks according to established policies and procedures.
- Perform other related duties as assigned.
Benefits
- Medical
- Dental
- Vision
- Paid Time Off (PTO)
- Floating Holiday
- Simple IRA Plan with a 3% Employer Contribution
- Employer Paid Life Insurance
- Employee Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
