Description: Job Summary:
Under indirect supervision, processes insurance claims, reports and billing for compensation of patients and members for medical disability benefits; processes applications from medical/life insurance, supplemental benefits and assigned accounts; obtains background information; makes arrangements to obtain monies owing; performs other collection responsibilities as needed; abides by state collection and credit regulations; interprets and complies with state/federal regulations, laws and guidelines in reference to third party payers; processes VRs for billing; maintains current knowledge of Kaiser Health Plan benefits and policies; acts as Kaiser representative.

Essential Responsibilities:

Receives, reviews, and controls requests for medical information, visit records, nurse/doctor notes and other pertinent documents; verifies completeness and accuracy; ensures efficiency in processing of claims; obtains medical charts and other data pertaining to request.
Audits, abstracts, and summarizes pertinent data from patient medical records, nurse/doctor notes and other documents; processes insurance claims and reports in compliance with state/federal regulations, laws, guidelines and Kaiser Health Plan policies; obtains physician signature and/or signs as provider representative; prepares service charge letters and invoices referring to fee schedule.
Performs follow-up with insurance companies, agencies, and/or patients; researches and takes action as required.
Prepares and audits visit records and nurse/doctor notes using various fee schedules; prepares documents (e.g. charges, payments, adjustments) with Charge Description Master codes, required billing coding conventions, and batch totals.
Communicates and corresponds effectively with insurance carriers, intermediaries, members, doctors, outside providers and patients; provides in-service orientation to other departments/personnel; obtains complete and valid information; ensures collectability and maximum reimbursement of revenues.
Maintains familiarity and open communication with state, federal and community agencies, insurance carriers, intermediaries and others within Kaiser organization; ensures proper and adequate exchange/interpretation of data and information; ensures maximization of payments.
Collects monies owing for all inpatient/outpatient services rendered from third party payers, employers, patients, guarantors.
Contacts debtor by telephone and/or correspondence; arranges for collection of monies owing; abides by state and federal collection and credit rules and regulations; schedules interviews with debtors; maintains positive customer relationships through effective communication and follow-up.
Analyzes history of delinquent accounts; determines whether account is collectible; prepares write-off accounts; attaches pertinent information to assist outside attorney; submits to supervisor for review; summarizes monthly write-off report (e.g. breakdown of amounts, service locations, date of service, H.P./N.P. and over-all reason for assignment to collection agency).
Generates appropriate adjustments; researches documents and all other available sources to determine validity of adjustment; submits back-up to data entry for key punching function.
Documents and records on HPMS computer system all collection action taken on individual accounts (e.g. data collection contact made, data of promised payment, credit arrangements, insurance filing date and all other pertinent information); maintains tickler system to monitor promised payment.
Skip traces all mail returns; researches internal and external documents and all other sources to determine whereabouts of debtor; generates file maintenance to update patient demographics for rebilling when different address obtained.
Operates standard office equipment; refers difficult problems to supervisor.
Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.
Performs other duties and accepts responsibility as assigned. Basic Qualifications: Experience

One (1) year collections or medical insurance claims processing experience.
Education
High school diploma; or equivalent combination of education (lesser) & experience may be considered in lieu of requirements. License, Certification, Registration N/A Additional Requirements:
Demonstrated ability to perform diversified clerical functions and basic accounting procedures.Demonstrated ability to motivate debtors to pay.Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, influence, interpersonal relations, oral communication, problem solving, teamwork, and written communication.Talking to co-workers, customers, outside vendors, and on the telephone.Reading, writing, speaking, understanding English.Training/giving and receiving instructions.Mathematical ability, attention to detail (e.g. organization, prioritization, proofing), concentration, and alertness. Preferred Qualifications:
Two (2) years collections experience in healthcare field.Knowledge of medical terminology, CPT-4 and ICD-9-CM coding.Knowledge of mainframe collections applications.10-key by touch.Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.Post high school coursework in accounting.