Claims Examiner - Temporary

KHS•Bakersfield, CA

15d

About The Position

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical). This is a full-time temporary position. If selected, onboarding will be completed through a staffing agency. About us Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Requirements

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.

Responsibilities

Resolve system suspended claims for:
PCPs
Labs
Radiology
Less complicated specialists
Physical Therapy
Prepare claims that must be routed to other departments for further review.
Review difficult claims with guidance from Claims Supervisor.
Responsible for identifying billing errors and possible fraudulent claims submissions.
Obtain eligibility verification and other health insurance coverage by Internet or POS.
Responsible for correct manual calculation of benefits when applicable.
Responsible for identifying 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.
Regular Predictable attendance.
Adheres to all company policies and procedures relative to employment and job responsibilities.