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.

Foundation for Medical Care of Kern County

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