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:
Expedite larger dollar accounts to ensure revenue optimization for prompt payment. Monitors to ensure all insurance balances are followed up in a timely manner. Performs accurate and timely billing of insurance claims in accourdance with policies and procedures of Maui Health and in compliance with state/federal regulations, payer health plan guidelines, and third-party payer requirements. Performs follow-up with insurance companies, agencies, and/or patients; researches and takes action as required.
Ensures charges from Charge Description Master is accurately reflected in the patients medical records via claims edits and self-audits. Perform audits as needed for quality control and to ensure efficient follow up. 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.
Basic Qualifications:
Experience
Minimum one (1) year collections or administrative experience.
Education
High school diploma.
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.
Preferred Qualifications:
One (1) year experience medical insurance claims processing.
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.
COMPANY: KAISERTITLE: Patient Accounting RepresentativeLOCATION: Wailuku, HawaiiREQNUMBER: 1257962External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.