Job Summary:The purpose of this position is to ensure accurate, compliant, and timely billing and appropriate reimbursement for all inpatient, outpatient and professional medical and dental service from all payers for service rendered by KPNW. This may include accurate and timely identification and completion of registration, billing, payment posting, contractual write-offs, adjustments, follow-up, and collection of unpaid accounts, per state and federal insurance regulations for members and non-members receiving services at Kaiser Permanente.Essential Responsibilities:
Review and correct all billable claims (primary, secondary, tertiary) in appropriate billing software programs in accordance with specific payer guidelines and requirements. Work to resolve questions related to the ICD-9 (10), CPT/HCPCS, Revenue Codes, Modifiers, charge entry errors and other questionable claim elements. Review line items in the on-line system to ensure a correct patient balance. Validate treatment plans, ABNs, authorizations, and submit the information appropriately on the correct payer form/system. Verify patient demographics and insurance coverages through on-line verification systems.
Follow-up with all payers on accounts receivable to ensure prompt and accurate reimbursement, per insurance guidelines. Review reimbursement against the payments received from Kaiser co-payments, government payers and other payer sources. Submit requests for adjustments, ABNs, appeals, credit balances, and refunds. Reconcile accounts by determining the correct insurance and patient responsibility through interpretations of payment and denial codes on the explanation of benefits sent by payer. Make adjustments in legacy computer system.
Document in account notes reasons for billing delays and actions taken. Review and correct account discrepancies. Work all assigned work queues to establish timely billing. Review and respond to mail, correspondence, and reports on a daily basis. Process requests for co-pay summaries and/or itemized bills.
Review claim reports, resolve issues and resubmit claims. Review and resolve non-covered charges according to procedures, and review and write-off charges that are not appropriate.
Perform other duties as requested, consistent with job description.
Basic Qualifications:
Experience
Minimum one (1) year of experience in medical billing and/or patient accounting, claims adjusting on a complex on-line system.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.
Education
High school diploma or GED equivalent (required at time of hire).
License, Certification, Registration
N/A
Additional Requirements:
Working knowledge of Excel and other business software.
Type/keyboard 20 wpm.
Demonstrate 10-key calculator ability.
Basic knowledge of all aspects of UB-04 and/or CMS 1500 fields and requirements.
Working knowledge and application of medical terminology, standard billing codes.
Knowledge of state and federal insurance regulations.
Working knowledge of insurance regulations, as they pertain to collection issues.
Basic knowledge of accounting principles.
Accuracy with numbers.
Knowledge of telephone collection techniques.
Excellent verbal and written communication skills.
Problem solving, listening and conflict resolution skills.
Ability to communicate and negotiate effectively with customers and third party payers.
Excellent organization skills.
Detail oriented with organizational skills which involve the ability to prioritize and manage workflow, to produce high quality work, to work independently with minimal supervision and the ability to use good judgment.
Extensive computer and telephone experience.
Preferred Qualifications:
One (1) year of experience with medical terminology and coding guidelines.
Two (2) years of higher education in related study, or three years experience in medical billing field or at Kaiser Permanente related position.
Two (2) years general office experience working with complex online system.
Working knowledge of Kaiser Permanente Health Plan coverage and benefits.
Knowledge of Kaiser Permanente computer systems and applications.
Knowledge of Kaiser Permanente organization policies and procedures.
Knowledge of Kaiser Fee Schedule.
Knowledge of Kaiser Accounts Receivable systems.
Ability to quickly analyze and develop solutions to complex issues.
Knowledge of billing requirements, coverage and benefits of private health insurers, federal and state agencies.
Ability to simultaneously answer phones, both inbound and outbound, and record written information on-line.
To be able to perform complex detailed, confidential work in a highly distracting environment.
COMPANY: KAISERTITLE: Specialist, Insurance BillingLOCATION: Portland, OregonREQNUMBER: 1313425External 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.
