Precision Healthcare Claims Examiner I & II

Kern Health Systems; Bakersfield (CA); On-site; USD 29,000 - 44,000; Full time

Job summary

Kern Health Systems in California is seeking a Medical Claims Examiner on-site to review and process all types of medical and facility claims for payment accurately and timely, applying correct contract benefits and procedures. The role emphasizes claims auditing, denial of inappropriate claims, eligibility verification, and collaboration with supervisors to resolve complex cases.

The position requires high school diploma and at least one year of related experience, with a strong focus on

Qualifications

• High School Diploma or equivalent.
• Minimum of one year medical Claims Examiner processing experience.
• Strong organizational skills and the ability to make good decisions.

Responsibilities

• 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.
• Calculate benefits manually when applicable.
• Identify CCS eligible claims for further investigation.
• Report overpayment refund requests on SharePoint log.
• Maintain productivity and quality per guidelines.
• Attend work regularly and adhere to policies.

Education

High School Diploma (or equivalent)

Job description

Kern Health Systems in California is seeking a Medical Claims Examiner on-site to review and process all types of medical and facility claims for payment accurately and timely, applying correct contract benefits and procedures. The role emphasizes claims auditing, denial of inappropriate claims, eligibility verification, and collaboration with supervisors to resolve complex cases.

The position requires high school diploma and at least one year of related experience, with a strong focus on