Claims Adjudicator 1 in Bakersfield, CA at Volt

Date Posted: 9/7/2020

Job Snapshot

Job Description

Volt has an awesome opportunity for professionals who have experience in Healthcare, to work for a reputable company in the Bakersfield area! 

Responsible for processing claims for multiple groups for medical, dental, and vision benefits. Communicates with plan sponsors regarding claims as well as the employees or providers on questions that may arise.

Responsibilities

  • Resolve system suspended claims.
  • Initiate contractual adjustments to claims and process for payment.
  • Ascertain that a valid authorization exists for each claim prior to payment.
  • Research claims that do not have all the required information for processing and request claim correspondence.
  • Process denials in accordance with contractual arrangements and policy guidelines.
  • Process claim reversals and corrections.
  • Audit claims for “unbundled charges” and correct use of CPT, RVS, ICD-10, HCPCS codes.
  • Prepare and refer claims to other departments for review.
  • Responsible for identifying billing errors and possible fraudulent claims submissions.
  • Manual calculation of benefits when applicable.
  • Identify requests for over-payment refunds.
  • Process all claims for specialties assigned to Adjudicator 1.
  • Assist with processing of claims assigned to Adjudicator Trainee when required.
  • Be flexible and adaptable.
  • Promote departmental and organizational goals.
  • Know and follow applicable safety standards.
  • Take the initiative in offering your help to co-workers in overload situations (when possible).
  • Other duties and responsibilities as assigned.
  • Perform other tasks and duties as assigned in a timely manner.

Expectations

  • Maintain quality scores of a minimum of 95% for Level 1 Specialties
  • Maintain production goal by length of employment on Level 1 Specialties:

Education

High School or better.



Preferred Experience

  • Minimum of 2 + years’ experience in medical billing and/or claims processing.
  • Must be able to communicate effectively, both written and verbal.
  • Knowledge of medical terminology required.
  • Ability to organize and prioritize workload and multi-task.
  • Working knowledge and proficiency with Microsoft Office applications (Word, Excel, Outlook, etc.)
  • Proven ability to work with all matters of a confidential nature.
  • Ability to use correct punctuation, grammar and spelling.

If your experience matches what is listed above, please email your resume directly to Shelley at smorris@volt.com

Volt is an equal opportunity employer