Website Kaiser Permanente
Under general supervision, analyzes, reviews and processes authorization and payments for outside medical services. Researches and resolves inquiries from outside providers; educates members, physicians, outside providers and staff regarding the referral process. Updates and edits authorization and payment data into Authorized Outside Medical Services system (AOMS). Recommends changes/additions to enhance service levels and cost benefits.
- Analyzes and evaluates each outside medical services bill for appropriateness of charges and processes for payment ensuring payment is made only for authorized services, procedure codes are consistent with diagnosis codes and services are not unbundled. Investigates and resolves billing problems.
- Processes non-purchase order invoices, employee expense reports and other requests for payment.
- Interprets existing contract language and responds to inquiries from outside providers regarding contractual arrangements. Utilizes multiple mainframe systems to determine primary payer status of pending referrals and answers inquiries of patients and providers.
- Works closely with KFHP case managers to inform them of all members in non-Kaiser hospitals to expedite repatriation and patients and providers to answer inquiries.
- Investigates and resolves vendor/department inquiries.
- Identifies impact of contractual agreements on actual costs and alerts supervisor of findings that indicate unfavorable impact of cost containment efforts.
- Monitors billing practices of outside providers. Reviews and processes Authorizations for Medical Care which involves verifying eligibility, monitoring benefit limits and assigning reason and service codes.
- Ability to prioritize work in a high volume demanding environment.
- Previous experience working with a mainframe database claims processing/billing system
- Must be able to work in a Labor/Management Partnership environment.
- Previous medical billing office experience in a hospital or clinic environment required.
- Excellent customer service, telephone presentation and problem solving skills.
- Knowledge of medical terminology and application of medical billing codes or claims processing experience at a senior level.
Company: Kaiser Permanente
Vacancy Type: Full Time
Job Location: Modesto, CA, US
Application Deadline: N/A