About the position
The position involves monitoring patient and insurance accounts receivables to achieve and maintain department aging guidelines. The role requires proactive communication with collectable accounts within assigned financial classes, ensuring that members and patients are the primary focus of all actions. The individual will develop and sustain productive relationships with members and patients, actively seeking to understand their circumstances, problems, expectations, and needs. Building rapport and cooperative relationships is essential, as is considering how actions will affect members and responding quickly to meet their needs and resolve any issues that arise. In addition to these responsibilities, the position requires compliance with all Kaiser Permanente quality, safety, and emergency policies and procedures. The individual must demonstrate quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensuring patient safety in the preparation and provisioning of care is critical, including adherence to protocols such as using two patient identifiers and procedural timeouts. The role also involves reporting safety hazards, accidents, incidents, and unsafe working conditions promptly. The individual will maintain active knowledge of quarterly changes and updates to payor regulations and will work all accounts in assigned Work Queues per department guidelines. Responsibilities include performing adjustments within department guidelines, reviewing account records to resolve issues, and supplying necessary documentation to secure maximum payment. The position requires accurate interpretation of denials and Explanation of Benefits, as well as detailed explanations of account history and accurate documentation of account activity in the appropriate systems of record. The individual will also review accounts for possible legal action or bankruptcy notification and initiate appropriate actions, as well as review accounts for potential refunds and initiate necessary paperwork. Additionally, the individual will act as a liaison or department representative regarding billing issues, provide technical and clerical support as needed, and offer training to new employees and cross-training as assigned. Other duties may be assigned by management as necessary.
Responsibilities
- Monitors patient and insurance accounts receivables to achieve and maintain department aging guidelines.
- Makes proactive attempts to contact collectable accounts within assigned financial classes using various communication tools.
- Develops and sustains productive member/patient relationships by understanding their circumstances, problems, expectations, and needs.
- Ensures compliance with Kaiser Permanente quality, safety, and emergency policies and procedures.
- Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership.
- Ensures patient safety in the preparation and provisioning of care related to medications, procedures, infection prevention, and fall prevention.
- Reports safety hazards, accidents, incidents, and unsafe working conditions promptly.
- Maintains active knowledge of quarterly changes and updates to payor regulations.
- Works all accounts in assigned Work Queues per department guidelines.
- Performs adjustments within department guidelines.
- Reviews account records to resolve issues and supply needed documentation for maximum payment.
- Accurately interprets and works denials and Explanation of Benefits.
- Provides detailed explanations of account history and accurately notes account activity in systems of record.
- Reviews accounts for possible legal action and/or bankruptcy notification and initiates appropriate action.
- Reviews accounts for potential refunds and initiates paperwork/documentation when appropriate.
- Receives and works correspondence within department guidelines.
- Acts as a liaison or department representative regarding billing issues.
- Provides technical and clerical support when needed.
- Provides training to new employees and cross-training as assigned.
- Performs other duties as assigned by management.
Requirements
- Minimum two (2) years of medical billing and two (2) years of health care collections experience required OR four (4) years of collection experience required.
- High School Diploma or General Education Development (GED) required.
- Must pass basic MS Word and Excel tests with 80% accuracy.
- ICD 9, CPT coding and medical terminology exposure, as they relate to collections, required.
- Knowledge of current insurance rules and regulations is necessary.
- Proven ability to research, resolve, and accurately document complex billing issues.
- Proven ability to communicate and explain complex issues in writing and verbally.
- Ability to work cooperatively in a team environment is essential.
- Must be detail oriented.
- Demonstrated customer service skills and customer focus abilities, with an understanding of Kaiser Permanente customer needs.
