Under the direct supervision of the department Supervisor, this position is responsible for using computerized internal system applications to post payments, process, and review adjustments from insurance carriers. Within departmental guidelines, reviews explanations of benefits, compares payments with charge information, prepares and processes adjustments based on review of EO - Bs for non-standard Fee Schedule and for non-payment or underpayments. Maintains reporting of trends for billing erro... more details
Description: Under the direct supervision of the department Supervisor, this position is responsible for using computerized internal system applications to post payments, process, and review adjustments from insurance carriers. Within departmental guidelines, reviews explanations of benefits, compares payments with charge information, prepares and processes adjustments based on review of EOBs for non-standard Fee Schedule and for non-payment or underpayments. Maintains reporting of trends for billing errors, downcoding and other carrier specific practices.
Essential Functions:
- Interacts daily with various departments, vendors and payers to determine appropriate disposition of payments received.
- Reconciles and posts payments to accounts receivable systems.
- Processes adjustments on a line item basis.
- Researches and determine the appropriate application of undistributed payments.
- Processes dishonored check activity.
- Transfers liability of balances.
- Reviews EOB's for non-standard Fee Schedule reductions and for non-payment or under payment trends based upon carrier practices that may affect reimbursement.
- Maintains EOB files as needed.
- Processes assigned KP HealthConnect work queues.
- Provides customer service liaison between payers, vendors and Kaiser.
- Performs other related duties as assigned including but not limited to special projects.
- Note: Internal PFS candidates may have job advancement opportunities via the PFS Career Ladder, and should consult with their supervisor and/or manager.
Basic Qualifications:
Experience
- Minimum two (2) years of bookkeeping, accounts receivable, Collector, Biller or Patient Billing Resolution experience or any combination of the above, with both years in a health care environment within the last four (4) years.
- The Basic Computer Literacy Assessment score must be current within one (1) year (contact Local HR Office for testing). Must obtain passing score on the Basic Computer Literacy Assessment (passing score set at 75).
Education
- High School Diploma or GED.
- Basic minimum required quals OR successful completion of the PFS Career Ladder curriculum that is mapped to that position.
License, Certification, Registration
- N/A
Additional Requirements:
- Proficient in Excel, Word and Windows.
- Strong interpersonal, and verbal and written communication skills.
- Ability to read, write and perform basic mathematical computations at a high school level.
- Ability to work well in a team environment and within the Labor
- Management Partnership guidelines and effectively participate in Unit Based Teams. Ability to sit for long periods of time.
- Ability to use general office equipment including telephones, fax, copier, etc.
- Ability to lift a minimum of 20 pounds.
Preferred Qualifications:
- AA degree in business or certification in insurance billing issued by an accredited institution.
- Ability to demonstrate knowledge of federal Workers Compensation Regulations, Relative Value Studies (RVS), Fee Schedule Allowance and reduction and medical terminology and/or Billing.
- Working knowledge of ACCESS.
- Working knowledge of Generally Accepted Accounting Principles (GAAP).
- Demonstrates knowledge of the SCAL and NCAL Uniform Chart of Accounts, all systems - North and South, such as ARBIS, ARRS, Foundations, KPTPX, SAR (NCAL and SCAL), CUBS, OPAS, CIPS.
- Uses all NCAL and SCAL systems to determine correct account for payment processing.
