Claims Examiner I: Precise Billing & Compliance

Kern Family Health Care; Bakersfield (CA); On-site; USD 28,929 - 44,083; Full time

Job summary

Kern Health Systems is seeking a dedicated Claims Examiner in California to review and process medical and facility claims from contracting and non-contracting providers and subscribers for payment in a timely and accurate manner. This role ensures correct application of contract benefits, policies, and procedures and supports efficient claims auditing.

You will apply policy guidelines, verify eligibility, identify billing errors and potential fraud, and route complex cases to appropriate

Qualifications

• High School Diploma required.
• Minimum of one year medical Claims Examiner processing experience.

Responsibilities

• Review and process all types of medical and facility claims for payment in a timely and accurate manner.
• Apply correct contract benefits, policies and procedures.
• 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 claims submissions.
• Obtain eligibility verification and other health insurance coverage by Internet or POS.
• Responsible for 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.
• Regular predictable attendance.
• Adheres to all company policies and procedures relative to employment and job responsibilities.

Education

High School Diploma

Job description

Kern Health Systems is seeking a dedicated Claims Examiner in California to review and process medical and facility claims from contracting and non-contracting providers and subscribers for payment in a timely and accurate manner. This role ensures correct application of contract benefits, policies, and procedures and supports efficient claims auditing.

You will apply policy guidelines, verify eligibility, identify billing errors and potential fraud, and route complex cases to appropriate