Revenue Cycle / Patient Accounts Specialist III, Back

Kaiser Permanente • Pasadena, CA

71d

About The Position

In addition to the responsibilities listed below, this position may also be responsible for interpreting broad guidelines to process and resolve rejections and denials from all insurance payers to ensure service costs are charged; and processing payer denied claim and underpayments; researching, coping, 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; independently researching databases/work ques and engaging/contacting and mentoring others to ensure determine the availability of third party, workers compensation, and secondary coverage funding options for patient bills; using templates and comprehensive foundational knowledge of business practices to negotiate payment plans and to set terms of pay agreement; providing customer service while explaining the application process, processing applications and disposition, following policy regulations and providing MFA status, providing quality assurance; performing standard and nonstandard collection interactions to defined set of patient accounts and collect payments; monitoring payment plans while determining and recommending if agreements should be sustained or cancelled; approving adjustments authority to handle unique circumstances; documenting process forms and obtaining signatures for service locations with Medicare, Medicaid, new facilities, service offers, or commercial enrollment and setting up financial reimbursement with the Treasury; using comprehensive knowledge of business practices to identify and escalate reconciliation issues while performing quality audits; using comprehensive knowledge providing liaison for system workflows to ensure appropriate bad dept assignment and performs the reconciliation between billing system and the vendor.

Requirements

• Associates degree in health care administration, business administration, or related field.
• Minimum one (1) years of experience in data analytics, merchant services, clinic/hospital operations, banking, health care billing and collections, or relevant experience.

Responsibilities

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
• Listens to, seeks, and addresses performance feedback; provides mentoring to team members.
• Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses.
• Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions.
• Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate.
• Supports, identifies, and monitors priorities, deadlines, and expectations.
• Ensures their own work is in compliance by adhering to federal and state laws, and applicable compliance standards.
• Reviews high-risk denials to determine the root cause by leveraging financial clearance and correct coverage, coding, or billing knowledge.
• Facilitates performance management initiatives by following general application of standard strategies to monitor quality and productivity metrics.
• Facilitates process management initiatives by coordinating with operations managers, process improvement, IT, clinicians, and health plan managers.
• Facilitates project management initiatives by contributing to project execution and management efforts.
• Facilitates regulatory reporting by learning, researching, and applying regulation standards.
• Facilitates systems management initiatives by integrating new systems processes with the teams work.
• Facilitates training by providing targeted training to peers based on approved curriculum.
• Develops training materials by identifying education and training requirements that reflect revenue cycle changes.

What This Job Offers

• Industry: Ambulatory Health Care Services
• Education Level: Associate degree