• Job Description

  Req#: 1167989
  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 Functions:
  
  - 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, ABN's, authorizations, and submit the information appropriately on the correct payer form/system.
  
  - Verify patient demographics and insurance coverage 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, ABN's, 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.
  
  - This job description is not all encompassing.

• About the company

  Providing high-quality, affordable health care services and improving the health of our members and the communities we serve.

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