Description
Location: Bakersfield, CA 93309
Classification: Full-Time
This position is non-exempt and will be paid on an hourly basis.
Schedule: Monday-Friday 8am-5pm
Benefits:
· Medical
· Dental
· Vision
· Simple IRA Plan
· Employer Paid Life Insurance
· Employee Assistance Program
Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $21.50 and $26.87. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.
Position Summary:
The Claims Operations Support Specialist role provides administrative and operational support to the Claims Department. This position is responsible for handling the intake, processing, distribution, and tracking of claims and supporting documents, as well as physical mail retrieval and interdepartmental delivery. The Claims Operations Support Specialist employee plays a key role in maintaining the flow of documentation between internal teams and external sources and ensures claims documentation is handled efficiently and in compliance with internal and regulatory standards
Requirements
Job Duties and Responsibilities:
• Pick up physical claims mail from designated post office locations, as assigned.
• Receive, date stamp, sort, and distribute incoming and outgoing mail and claims documentation.
• Identify and escalate claims lacking required information.
• Distribute interoffice mail and claims-related documents to internal departments or staff.
• Maintain a delivery log and document transport chain where applicable.
• Scan, log, and track all daily mail and claims according to departmental procedures.
• Load EDI and paper claims to transaction system.
• Reconcile EDI claim counts
• Sort and route Provider disputes and other claim-related items for proper handling.
• Ensure timely and accurate data entry of incoming claims, applications, and supporting documentation.
• Maintain organized physical and electronic filing systems for incoming and outgoing documents.
• Perform regular quality control checks to ensure documentation accuracy and completeness.
• Respond to internal and external inquiries regarding claim status, routing, and general support.
• Communicate with Claims team and other departments to ensure timely resolution of documentation issues.
• Monitor and maintain mailroom equipment (scanners, copiers, printers), ensuring items are in working condition.
• Perform routine equipment maintenance or coordinate service requests as needed.
• Assist with preparing reports on claims processing and mail volume as required.
• Maintain confidentiality and compliance with company policies, HIPAA, and all regulatory guidelines.
• Support special projects or perform other related duties as assigned.
• Evaluate claims for appropriateness of payment, considering factors such as eligibility, benefits, authorizations, coding, compliance, contracted payment terms or relevant fee schedule, and health plan contracts. As directed by Claims Management.
• Stay informed about annual changes in contracts and apply the correct terms to claims, ensuring adherence to contracted payment terms and health plan agreements.
• Assist with Customer Service calls and inquiries as needed.
• Work independently on assigned tasks and activities based on established policies and procedures, demonstrating autonomy and accountability.
• Assist with the preparation and coordination of materials and documentation required for health plan audits, ensuring accuracy, compliance, and timely submission
• Other related duties as assigned
Qualifications:
• High school diploma or equivalent required.
• One or more years of experience in healthcare, medical billing, or managed care environment preferred.
• Familiarity with claims processes and workflows.
• Familiarity with CPT, HCPCS, ICD-10, ASA, Revenue Codes, etc.
• Strong attention to detail, organizational skills, and communication abilities.
• Proficient in Microsoft Office (Excel, Word, Outlook).
• Ability to type 40 WPM or 5,000 KSPH.
• Comfortable working independently and collaboratively in a fast-paced environment.
• Familiarity with office equipment (including a photocopy machine, scanner, facsimile machine, etc.).
• One or more years working in a healthcare or other related business environment: experience in medical billing services and/or managed care environment preferred.
