Job ID: 1805031
Reference Code: VI-Payers-Side Medical Claims 1+yr Exp
We are hiring Payer side Medical Claims Examiner in Bakersfield, CA! We are seeking candidates with at least 1 year of recent payer-side medical claims adjudication experience working for a health plan, insurance carrier, HMO, managed care organization, or third-party administrator (TPA). Review, audit, adjudicate, and process medical and facility claims accurately and timely
This temporary opportunity offers up to $22.00/hour, a hybrid/remote work environment, and the opportunity to work with a respected healthcare organization. If you have experience processing, reviewing, auditing, and adjudicating medical claims, we encourage you to apply today.
Qualifications
High School Diploma or equivalent
Minimum 1 year of recent payer-side medical claims examiner or claims adjudication experience
Experience working for a:
Health Plan
Insurance Carrier
HMO
Managed Care Organization
Third-Party Administrator (TPA)
Strong understanding of:
Medical claims adjudication
Benefit interpretation
Provider contracts
Claims payment methodologies
Medical terminology
Knowledge of:
CPT, HCPCS, and ICD-10 coding
CMS-1500 and UB-04 claim forms
Eligibility verification processes
Experience handling:
Suspended claims
Denied claims
Adjusted claims
Manually reviewed claims
Strong organizational, analytical, and decision-making skills
Experience in use of Medical Claims Processing Systems
Electronic Health Records (EHR)
Electronic Practice Management (EPM) Systems
Practice Management Software
Online Eligibility Verification Tools
SharePoint
Microsoft Office Suite
Important: Provider-side medical billing, collections, accounts receivable, patient financial services, or physician office billing experience alone does not meet the minimum qualifications unless accompanied by direct payer-side claims adjudication experience.
Resolve suspended claims involving primary care providers, labs, radiology, physical therapy, and specialty services
Apply plan benefits, provider contracts, policies, and procedures
Deny inappropriate claims according to established guidelines
Investigate billing discrepancies and identify potential fraudulent submissions
Manually calculate benefits when applicable
Verify eligibility and insurance coverage using online tools
Route complex claims for additional review when necessary
Document overpayment refund requests and maintain required logs
Maintain productivity and quality standards
Collaborate with internal departments to ensure accurate claim resolution
Ready to put your payer-side medical claims experience to work?
Apply today if you have recent experience as a Medical Claims Examiner, Claims Adjudicator, Healthcare Claims Processor, Insurance Claims Specialist, or Managed Care Claims Analyst. Qualified candidates will be contacted for the next steps in the hiring process.
Submit your resume today to be considered for this opportunity!
Equal Opportunity Employer / Disabled / Protected Veterans
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https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
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https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.