Job Summary:In addition to the responsibilities listed below, this position may also be responsible for exercising judgment and using existing guidance to process and resolve rejections and denials from insurance payers to ensure service costs are charged; and identifying trends, identifying the root cause of issues, and resolving workflow or build issues in collaboration with management; researching, copying, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services); verifying and validating insurance coverage; pre-registration contacting of payer; applying insurance to a patient account; interviewing patients to determine coverage; partnering with vendors to find coverage for underinsured and self-pay patients; recommending plans to ensure accurate processing of third party, workers compensation, and secondary coverage; using templates and advanced knowledge of business practices to negotiate payment plans and to set terms of pay agreement; performing collection interactions to defined set of moderately complex patient accounts; providing guidance on a portfolio (e.g., negotiate, agree, monitor payment plans) while determining if agreements should be sustained or cancelled; approving adjustments authority to handle unique circumstances; documenting process forms, obtaining signatures, and enrolling service locations with Medicare, Medicaid, new facilities, service offers, or commercial enrollment and setting up financial reimbursement with the Treasury; using working knowledge of business practices to resolve escalated reconciliation issues with deposits within operations, Accounting, Treasury, IT, payer, and banks to ensure consistency across accounts; identifying issues and/or performing quality reviews of payment posting functions; using advanced knowledge to provide liaison for system workflows to ensure appropriate bad dept assignment and perform the reconciliation between billing system and the vendor; taking and responding to queries from patients or insurers; providing root-cause analysis and recommending improvements; monitoring credit; preparing work list; performing quality assurance; preparing accounts payable documentation; maintaining and monitoring requests for recoupment and take back from insurance companies; reconcile credit card and check refund workflows; performing quality reviews, recommending improvements, reconciling patient files, and partnering across teams to resolve issues.Essential Responsibilities:
Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
Ensures their own work is in compliance by: adhering to federal and state laws, and applicable compliance standards and providing some feedback to the team.
Ensures accurate patient accounts by: taking escalated inquires from providers, members, attorneys, and other insurance personnel to research and answer moderately complex billing questions, trending of complaints and recommending solutions for prevention.
Reviews the denial process by: leveraging financial clearance and correct coverage, coding, or billing advanced knowledge and finds trends from data analysis and partners across departments to make recommendations.
Ensures finances are completed accurately by: running reports to identify revenue shifts and partners with Finance and management.
Facilitates performance management initiatives by: independently applying strategies and concepts to monitor quality and productivity metrics associated with operational improvement and address performance gaps to ensure the teams work meet established performance levels and analyzes data and experiential information to generate complex report outs and facilitates impactful information to revenue cycle leadership to make next-step determinations. following general application of standard strategies to monitor vendor performance of collections, coding services, systems, coverage validation, income verification and escalating quality issues to ensure quality.
Facilitates process management initiatives by: using advanced knowledge of business practices to coordinate with operations managers, IT, clinicians, and health plan managers to plan process improvement projects and identify business needs while also planning tasks with limited direction to translate business needs into project requirements that are then used to develop project specifications and action plans.
Facilitates project management initiatives by: contributes to project execution and management efforts by collaborating with stakeholders across functions to ensure the project is successfully executed and project-based changes are implemented, with limited guidance.
Facilitates regulatory reporting by: learning, researching, and applying regulation standards while also reviewing the accuracy of the identified teams work and recommending corrections.
Facilitates with vendor relationships by: maintaining and supporting relationship with vendors by working with various internal contacts to facilitate execution of work in accordance with organizational guidelines and guidance from senior leaders.
Facilitates systems management initiatives by: contributing to plans for new systems updates and integrating new systems processes with the teams work while providing recommendations for new updates such as testing, validating, and partnering to setup work ques (e.g., flush the system), partnering with other entities.
Facilitates training by: providing specialized coaching and training to peers based on work curriculum.
Develops training materials by: using advanced knowledge of business practices to identify education and training requirements that reflect revenue cycle changes to develop strategic training content.
Minimum Qualifications:
Bachelors degree in health care administration, business administration, or related field. OR Minimum three (3) years of experience in data analytics, merchant services , clinic/hospital operations, merchant services, banking, health care billing and collections, or relevant experience.
Additional Requirements:
N/A
COMPANY: KAISERTITLE: Revenue Cycle / Patient Accounts Specialist IV, BackLOCATION: Pasadena, CaliforniaREQNUMBER: 1321768External 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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
