Claims Examiner I/II - Temporary

Kern Family Health Care; Bakersfield (CA); On-site; USD 30,000 - 32,000; Full time

Job summary

Kern Health Systems is seeking a detail‑oriented claims processor to review and process all types of medical and facility claims for payment in an accurate and timely manner. The role involves applying contract benefits, policies, and COB guidelines in a fast-paced environment.

On-site, full-time temporary position with onboarding via staffing agency; level may be I or II based on experience. Candidates should have 1–2 years of medical claims experience and strong data entry skills.

Qualifications

• 1–2 years of medical claim payment or medical billing processing experience preferred.
• Experience investigating COB and applying contract benefits.
• Proficiency in data entry and interpreting medical terminology (CPT, ICD-9/10).

Responsibilities

• Review and process all types of medical and facility claims for payment in an accurate and timely manner.
• Deny inappropriate claims following policy guidelines.
• Obtain eligibility verification and other health insurance coverage by Internet or POS.
• Calculate benefits and ensure correct manual calculations when applicable.
• Identify billing errors and potential fraudulent claims submissions.
• Maintain productivity and quality in accordance with established guidelines.

Skills

Medical claims processing

Attention to detail

Independent worker

Communication

Education

High School Diploma or equivalent

Job description

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.

This position may be filled at the I or II level based on experience and qualifications.

• On-Site***

About Us

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.
• 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 guidelines.
• Perform other job-related duties as required.
• Regular Predictable attendance.
• Adheres to all company policies and procedures relative to employment and job responsibilities.

Employment Standards

High School Diploma from an accredited school or equivalent.

Up to (1-2) years of medical claim payment or medical billing processing experience.

Experience investigating COB.

Ability to calculate usual and prevailing fees.

Health maintenance organization (HMO) claims payment-processing experience is highly desirable.

Education And Experience

Computerized on-line data entry systems; organizational structure of medical claims processing; methods and procedures utilized in medical claims processing; medical terminology; CPT & ICD-9 coding; COB & subrogation investigation.

Adapt to a rapidly evolving work environment; work independently; communicate with a variety of personnel and providers.

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.

Pay Rate

CEI-22.00/hr

CEII-23.10/hr

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.