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Claims Reviewer ASC - Kern Rep - TEMPORARY

Location Bakersfield, California Job Number 1002023 Date posted 10/08/2021
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Ensures the integrity of outside medical payments for the organization by verifying the accuracy of data-entered information and by reviewing claims-related information and invoice adjudication/payment for compliance with contract terms and according to department/regional policy and procedures. Conducts research, assists with problem resolution within specialized areas such as Medicare, Multiplan, Workers' Compensation, Coordination of Benefits and Third Party liability. May provide education and feedback to staff involved in related processes and may assist with recovery of funds and response to appeals.

Essential Functions:

- Analyzes referrals and claims information for accuracy according to established guidelines.

- Provides education, feedback and reports as applicable.

- Assists with tracing sources of inaccuracies.

- Reports and proposes remedial action to appropriate manager.

- Prepares detailed analysis of claims activity and submits reports/findings as requested.

- Maintains records of special processing payment adjustments and check requests.

- Works with other departments as a resource regarding all aspects of Outside Medical Claims.

- Researches and provides reports as requested.

- Reviews processing of outside medical payments on a continuous basis.

- Audits and verifies documentation, approvals and accurate coding of provider service and accounting data.

- Monitors and coordinates special transactions, e.g., check adjustments and credits.

-  Performs data analysis for outside medical payments and provides performance feedback.

-  Formats and prepares statistical reports to assist with budget monitoring and financial analysis.

-  Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding.

-  Prepares special comprehensive reports as indicated or requested by management.

-  May provide education and feedback to staff involved in related processes.

-  May assist with recovery of funds and providing timely response to appeals.

Basic Qualifications:

• Two (2) years of claims analysis and medical billing experience.

• High School diploma or GED required.

• Knowledge of CPT, ICD, RBRVS, and other applicable references.

• Familiarity with outside medical systems and claims processing/adjudication processes.

• Demonstrated knowledge of both mainframe and personal computer programs.

• Excellent mathematical, written and verbal skills and demonstrated medical terminology competence.

• Demonstrated ability to act under limited supervision.

• Ability to understand, develop and implement procedures.


Preferred Qualifications:

• Bachelor's degree in accounting, audit, finance or a related field preferred.



• This is a  temporary position for approximately six (6) months.

Primary Location: California,Bakersfield,Discovery Plaza Medical Offices Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Temporary Employee Group/Union Affiliation: B20|UFCW|Local 770 Job Level: Individual Contributor Department: Main St Hlth Pavilion Bldg One - Medical Office Admin Services - 0806 Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.