Description : SEIU Local 105 - *$25.45-$28.95

May be entitled to translation / bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement.

Please refer to the respective collective bargaining agreement for additional information on such wage premiums : https : / / www.

lmpartnership.org / local-contracts.

Job Summary :

Coordinate insurance eligibility and benefits in accordance with state and federal regulations; obtain authorizations or pre-certification for services provided, and / or determine if patient has no insurance coverage.

Work closely with front end to resolve issues regarding terminated coverage (all insurance coverage, not limited to Kaiser), identify Medicaid eligibility, charity care and other insurance coverage as necessary.

Other related duties may be assigned.

Essential Responsibilities :

This position, knows and complies with all 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 but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs.

Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.

• Identify and verify primary and secondary insurance coverage for all new and existing patients and / or determine if the patient has no eligibility or coverage on the date of service.
• Employee is responsible for assessing where work flow improvements are necessary and communicate such recommendations to the appropriate supervisor.
• The employee will ensure that he / she follows departmental and Regional policies and procedures.
• Fills in for absent employees and assists employees with large workloads as needed.
• Creates guarantor accounts, adding and removing account coverage.
• Working from several spreadsheets / logs and update systems.
• Complete multiple workque assignments (as assigned daily).
• Add workers compensation related claim information to registration.
• Identify Coordination of benefits for commercial payors and update account status.
• Works closely with other departments to identify insurance coverage and determine eligibility.
• Submit Medicaid and Commercial Prior Authorization request for medical treatment and complete follow up work.
• Receive inbound calls from members related to billing questions.
• Make outbound calls to insurance companies, members and other health care providers for eligibility inquiries.
• Identify visiting members, create medical record number and add coverage for all future appointments.
• Special Projects may be assigned.

Basic Qualifications :

Experience

• Three (3) years of experience with insurance verification with medical benefit coverage.
• At least one (1) year of billing experiiance or two (2) years as a Patient Registration Associate.

Education

High school graduation or equivalent required.

License, Certification, Registration

N / A

Additional Requirements :

• Insurance Verification Clerk requires comprehensive knowledge of third party payer requirements with excellent communication and customer service skills.
• A comprehensive knowledge of applicable insurance laws, and regulations related to Workers Compensation, No-fault, coordination of Benefits (COB), Medicare, Medicaid, Tri-care, Champva including CHP policies,and Third-Party-Liability (TPL) is required.
• Employee must have the ability to operate a calculation and a personal computer including keyboard skills.
• Working knowledge of PC applications in work processing (MS Word) and spreadsheet software (MS Excel) is required 70% at Basic Level.
• Must be detailed oriented with good organizational and critical thinking skills and have the ability to multi-task.
• Must be able to work independently without direct supervision.
• Working knowledge of CPT-4, ICD-9 and medical terminology required.
• Working knowledge of commercial insurance primary and secondary payors.
• Knowledge of workers compensation guidelines.

Preferred Qualifications :

• Work experience in medical billing and collections with working knowledge of HCFA 1500, UB92 forms and other billing forms preferred.
• Experience working within the Resolute / Epic in a healthcare environment preferred.
• Understanding of Kaisers membership system, Common Membership and the claims system, Qcare preferred.
• Understanding of the electronic insurance verification using passport processes preferred.
• Knowledge of eSummit Exempla system preferred.

Primary Location : Colorado,Denver,Northfield Support Services

Scheduled Weekly Hours : 40

Shift : Day

Workdays : Mon, Tue, Wed, Thu, Fri

Working Hours Start : 08 : 00 AM

Working Hours End : 04 : 00 PM

Job Schedule : Full-time

Job Type : Standard

Worker Location : Onsite

Employee Status : Regular

Job Level : Individual Contributor

Department : Northfield Support Services - MFA Financial Counseling - 1608

Pay Range : $26.99 - $30.7 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.

Travel : Yes, 5 % of the Time

On-site : Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy.

At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do.

We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work.

Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

Last updated : 2024-05-02