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Experience:
No experience
Employment Type:
Intern/Co-op
Posted:
7/6/2015
Job Category:
Health Care Provider
Industry:
Health Care & Medicine
Patient Account Customer Service Representative
Kaiser Permanente | Portland, Oregon
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Job Description

The purpose of this position is to ensure that revenue is captured appropriately and that the member and non-member billings are correct.  Provide a high level of customer service and to act as a liaison between customers, other Kaiser departments and outside agencies in relations to billing and benefits.  Assess and determine the customer needs for programs, i.e., Charity, Medicaid, MFA, etc.
 
Essential Functions:
Responsible for answering a large volume of incoming calls in a timely and knowledgeable manner. 
Assess caller's needs and forward to ancillary departments when appropriate. 
Return calls within 24 hours. 
Advise caller of all outstanding balances in an effort to collect revenue.
Negotiate payment plans on outstanding balances. 
Identify patients who may qualify for financial assistance, charity care, or other government agency programs, according to Federal Poverty Guidelines. 
Work assigned work queues to ensure appropriate and timely actions are completed. 
Process and forward correspondence daily. 
Collaborate with ancillary departments, such as coding, membership services, and outside vendors. 
Compose and send requested documentation of account status and payments made, in a timely manner, while observing the guideline of HIPAA. 
Confirm with bankruptcy court regarding filing, and adjust account per KPNW Policy and Procedure. 
Process requests for co-pay summaries and/or itemized bills.
Complaints that cannot be resolved by the representative are immediately forwarded to the Supervisor/Manager. 
Communicates with Supervisor/Manager trends in billing issues. 
Audit accounts for accuracy and makes appropriate adjustments.
Research and resolve complex billing and credit balance issues on accounts. 
Reconcile accounts by determining both patient and insurance responsibility through Explanation of Benefits (EOB) information. 
Determine if an account is eligible for collections, and if the account has been referred to collections, refer caller to the appropriate agency. 
Monitor account activity by reviewing and notating each call in the appropriate system. 
Review and correct all demographic discrepancies. 
Maintain knowledge of KP and TPA insurance plans.
Performs other duties as requested consistent with the job description.
The purpose of this position is to ensure that revenue is captured appropriately and that the member and non-member billings are correct.  Provide a high level of customer service and to act as a liaison between customers, other Kaiser departments and outside agencies in relations to billing and benefits.  Assess and determine the customer needs for programs, i.e., Charity, Medicaid, MFA, etc.
 
Essential Functions:
Responsible for answering a large volume of incoming calls in a timely and knowledgeable manner. 
Assess caller's needs and forward to ancillary departments when appropriate. 
Return calls within 24 hours. 
Advise caller of all outstanding balances in an effort to collect revenue.
Negotiate payment plans on outstanding balances. 
Identify patients who may qualify for financial assistance, charity care, or other government agency programs, according to Federal Poverty Guidelines. 
Work assigned work queues to ensure appropriate and timely actions are completed. 
Process and forward correspondence daily. 
Collaborate with ancillary departments, such as coding, membership services, and outside vendors. 
Compose and send requested documentation of account status and payments made, in a timely manner, while observing the guideline of HIPAA. 
Confirm with bankruptcy court regarding filing, and adjust account per KPNW Policy and Procedure. 
Process requests for co-pay summaries and/or itemized bills.
Complaints that cannot be resolved by the representative are immediately forwarded to the Supervisor/Manager. 
Communicates with Supervisor/Manager trends in billing issues. 
Audit accounts for accuracy and makes appropriate adjustments.
Research and resolve complex billing and credit balance issues on accounts. 
Reconcile accounts by determining both patient and insurance responsibility through Explanation of Benefits (EOB) information. 
Determine if an account is eligible for collections, and if the account has been referred to collections, refer caller to the appropriate agency. 
Monitor account activity by reviewing and notating each call in the appropriate system. 
Review and correct all demographic discrepancies. 
Maintain knowledge of KP and TPA insurance plans.
Performs other duties as requested consistent with the job description.

Qualifications

Basic Qualifications:
Minimum of one (1) year experience in medical billing and/or patient accounting, claims adjusting on a complex on-line system.
High school diploma or GED equivalent (required at time of hire).
Working knowledge of Microsoft Excel and other business software.
Familiar with medical terminology, revenue codes, CPT-4 and ICD-9 (10) CM coding.
Basic knowledge of state and federal insurance regulations, including the Fair Debt Collection Practice Act for Federal, State and Regional laws.
Knowledge of bankruptcy, workers compensation, and insurance regulations, as they pertain to collection issues.
Demonstrated 10-key calculator ability.
Knowledge of telephone collection techniques.
Excellent verbal and written communication skills.
Problem solving, listening and conflict resolution skills.
Ability to communicate and negotiate effectively with customers.
Organizational skills, which involve the ability to prioritize and manage workflow, to produce high quality work, to work independently with minimal supervision, and the ability to use good judgment.
 
Preferred Qualifications:
Minimum of two (2) years higher education in related study, or three (3) years of experience in medical billing field or at Kaiser Permanente related position preferred.
Minimum of two (2) years general office experience working with complex online systems preferred.
Minimum of three (3) years prior collections experience preferred.
Minimum of one (1) year experience with medical terminology and coding guidelines preferred.
Working knowledge of Kaiser Permanente Health Plan coverage and benefits preferred.
Knowledge of Kaiser Permanente computer systems and applications preferred.
Knowledge of Kaiser Permanente organization policies and procedures preferred.
Knowledge of Kaiser Fee Schedule preferred.
Knowledge of Kaiser Accounts Receivable systems preferred.
Ability to quickly analyze and develop solutions to complex issues preferred.
Knowledge of billing requirements, coverage and benefits of private health insurers, federal and state agencies preferred.
Ability to simultaneously answer phones, both inbound and outbound, and record written information on-line preferred.
To be able to perform complex detailed, confidential work in a highly distracting environment preferred.
Basic Qualifications:
Minimum of one (1) year experience in medical billing and/or patient accounting, claims adjusting on a complex on-line system.
High school diploma or GED equivalent (required at time of hire).
Working knowledge of Microsoft Excel and other business software.
Familiar with medical terminology, revenue codes, CPT-4 and ICD-9 (10) CM coding.
Basic knowledge of state and federal insurance regulations, including the Fair Debt Collection Practice Act for Federal, State and Regional laws.
Knowledge of bankruptcy, workers compensation, and insurance regulations, as they pertain to collection issues.
Demonstrated 10-key calculator ability.
Knowledge of telephone collection techniques.
Excellent verbal and written communication skills.
Problem solving, listening and conflict resolution skills.
Ability to communicate and negotiate effectively with customers.
Organizational skills, which involve the ability to prioritize and manage workflow, to produce high quality work, to work independently with minimal supervision, and the ability to use good judgment.
 
Preferred Qualifications:
Minimum of two (2) years higher education in related study, or three (3) years of experience in medical billing field or at Kaiser Permanente related position preferred.
Minimum of two (2) years general office experience working with complex online systems preferred.
Minimum of three (3) years prior collections experience preferred.
Minimum of one (1) year experience with medical terminology and coding guidelines preferred.
Working knowledge of Kaiser Permanente Health Plan coverage and benefits preferred.
Knowledge of Kaiser Permanente computer systems and applications preferred.
Knowledge of Kaiser Permanente organization policies and procedures preferred.
Knowledge of Kaiser Fee Schedule preferred.
Knowledge of Kaiser Accounts Receivable systems preferred.
Ability to quickly analyze and develop solutions to complex issues preferred.
Knowledge of billing requirements, coverage and benefits of private health insurers, federal and state agencies preferred.
Ability to simultaneously answer phones, both inbound and outbound, and record written information on-line preferred.
To be able to perform complex detailed, confidential work in a highly distracting environment preferred.

About Kaiser Permanente

Company Description

Serving approximately 8.7 million members in nine states and the District of Columbia, Kaiser Permanente is America's leading nonprofit integrated health plan.

Kaiser Permanente's mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve.

Our Northern California Region provides integrated health care services to approximately 3.2 million members. Approximately 4,400 physicians of The Permanente Medical Group provide services at 20 medical centers and numerous medical offices.

Company History

Founded in 1945, Kaiser Permanente is the nation’s largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, Calif. It comprises:

  1.   • Kaiser Foundation Health Plan, Inc.

  • Kaiser Foundation Hospitals and their subsidiaries

  • The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

  • prepaid health plans, which spread the cost to make it more affordable

  • physician group practice to maximize their abilities to care for patients

  • a focus on preventing illness as much as on caring for the sick

  • an organized delivery system, putting as many services as possible under one roof

Mission & Values

As a health care organization in the 21st century, we have a mission--to provide quality care for our members and their families, and to contribute to the well-being of our communities.

Working Here

When you bring your career to Kaiser Permanente, the work you do directly affects the health of millions. From the business people who shape our policies, to the IT professionals enabling life-saving data, to the nurses and physicians on the front line of patient care, everyone here has a role to play in the care continuum. Knowing you have a place in that process and witnessing the outcome of the work you do is empowering. It gives you a cause to stand behind. And it makes you feel proud of the work you do every day. When people witness the impact of their contributions, they excel. Together we have the power to make a difference.

Hiring Information

The first step in beginning your career search is to look for open jobs that match your skills, qualifications, and interests. Each posting includes a description of the position and the minimum required qualifications. Once you find a position you are interested in, register for an account and provide your information for consideration online.

Benefits

As an employee, you are eligible for benefits according to your full-time/part-time status and the number of hours scheduled to work per week. Benefits may vary based on your Kaiser Permanente region, position, scheduled hours, and representation by collective bargaining or employee groups, but generally include:

  • generous vacation, holiday, and sick leave

  • medical care (including prescriptions), vision, mental health, and dental care

  • disability and life insurance coverage

  • educational opportunities and tuition reimbursement

  • employee assistance programs

  • health care, dependent care, and transit spending account options

  • retirement plans

In addition, we believe in recognizing stellar performance and sponsor a variety of programs designed to reward our skilled, innovative, caring, and committed staff.

In short, at Kaiser Permanente, we understand that there is a direct correlation between happy employees and happy members. We take pride in the compassion and dedication of our employees and find many ways to reward their hard work. In return, our employees take pride in being a part of a collaborative, professional team focused on quality, service, and care.

Honors & Awards

Kaiser Permanente of Northern California has earned an "Excellent" rating from the National Committee for Quality Assurance (NCQA)-the nation's leading reviewer of health plan quality for consumers and employers. Excellent is the top rating granted by NCQA, which reviews satisfaction surveys, preventive measures, physician credentialing, member services and improvement initiatives.*

Both our Northern and Southern California regions were the only health plans in California identified by the NCQA in its list of the best health care programs in the Pacific States. (NCQA's The State of Health Care Quality 2003)

The Joint Commission on Accreditation of Healthcare Organizations accredits all Kaiser Foundation Hospitals in California.

For the seventh straight year, no other health plan has earned higher ratings from the California Cooperative Health Reporting Initiative on more measures than Kaiser Permanente. The annual ratings measure clinical quality and member satisfaction. (CCHRI Report on Quality 2003)

Our Northern California region received more three-star "Excellent" ratings than any other health plan surveyed by California's Office of the Patient Advocate on California's Quality of Care Report Card 2003-04.

* Commercial HMO and Medicare-contracted product lines: April 2003.