Job Description

Job Posting: Medical Claims Processor

Job Description

Foundation for Medical Care of Kern County and HealthEdge Administrators is currently recruiting a Medical Claims Processor in Bakersfield, CA. We are looking for the right candidate to join our team! The ideal candidate has extensive professional medical claims processing, billing and/or coding experience, payment posting, insurance and benefits plan knowledge. Familiarity with Medicare guidelines is a plus. Attention to detail, critical thinking/decision making and adaptability are critical skills for this role. Previous medical claims processing experience preferred.

As a key member of our claims department, the Medical Claims Processor will be responsible for maintaining compliance with regulatory standards, and ensuring timely processing of claims. The ideal candidate will bring a strong attention to detail, excellent organizational skills, and a robust knowledge of medical terminology, medical insurance and healthcare knowledge. This is a critical role within our organization and requires a dedicated professional committed to upholding the standards of the Foundation for Medical Care of Kern County.

Our work environment includes:

• Modern office setting
• Work-from-home days
• Growth opportunities
• On-the-job training
• Relaxed atmosphere
• Regular social events

Duties and Responsibilities

• Processes medical claims with attention to detail and accuracy.
• Conducts detailed research to analyze claims information accurately.
• Evaluates benefit plans and fee schedules to ensure thorough and proper claims processing.
• Follows established guidelines set forth by Company, clients, and regulatory bodies.
• Meets or exceeds departmental production goals as determined by the Claims Manager.
• Maintains and updates claim files, including notes and electronic records.
• Communicates effectively with healthcare providers, patients, and insurance companies to solve claims-related issues.
• Maintains confidentiality and security of patient information according to privacy regulations and company policy.
• Participates in training sessions to stay updated on industry trends or changes in regulations.
• Assists in the implementation of new processes to enhance workflow efficiency.

Requirements

• Must possess knowledge of medical terminology and benefits, CPT, HCPCS, Revenue and ICD10 codes.
• Must possess knowledge of professional medical claims, including modifiers and medical procedures.
• Detail-oriented, self-starter with a strong desire to learn.
• Thoroughly researches and analyzes information, thinks critically.
• Able to adapt quickly to changing processes.
• Proficient in data-based systems and related technical software programs.
• Must possess the ability to perform mathematic equations.
• Must have high level of attendance in accordance with FMC Attendance Policy.
• High school diploma or equivalent required.
• Two years’ professional medical office experience, medical billing, payment posting, claims or appeals processing required.
• Certified Coder preferred.
• Familiarity with Medicare guidelines preferred.

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