PBS Insurance Verification Technician - CO

SEIU Local 105 - *$25.45-$28.95

"May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: ~~~.

Job Summary

Coordinate insurance eligibility and benefits in accordance with state and federal regulations; obtain authorizations or pre-certification for services provided, and/or determine if patient has no insurance coverage. Work closely with front end to resolve issues regarding terminated coverage (all insurance coverage, not limited to Kaiser), identify Medicaid eligibility, charity care and other insurance coverage as necessary. Other related duties may be assigned.

Essential Responsibilities

• This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.

• Identify and verify primary and secondary insurance coverage for all new and existing patients and/or determine if the patient has no eligibility or coverage on the date of service.

• Employee is responsible for assessing where work flow improvements are necessary and communicate such recommendations to the appropriate supervisor.

• The employee will ensure that he/she follows departmental and Regional policies and procedures.

• Fills in for absent employees and assists employees with large workloads as needed.

• Creates guarantor accounts, adding and removing account coverage.

• Working from several spreadsheets/logs and update systems.

• Complete multiple workque assignments (as assigned daily).

• Add workers compensation related claim information to registration.

• Identify Coordination of benefits for commercial payors and update account status.

• Works closely with other departments to identify insurance coverage and determine eligibility.

• Submit Medicaid and Commercial Prior Authorization request for medical treatment and complete follow up work.

• Receive inbound calls from members related to billing questions.

• Make outbound calls to insurance companies, members and other health care providers for eligibility inquiries.

• Identify visiting members, create medical record number and add coverage for all future appointments.

• Special Projects may be assigned.

Basic Qualifications:

Experience

• Three (3) years of experience with insurance verification with medical benefit coverage.

• At least one (1) year of billing experiiance or two (2) years as a Patient Registration Associate.

Education

• High school graduation or equivalent required.

License, Certification, Registration

• N/A

Additional Requirements:

• Insurance Verification Clerk requires comprehensive knowledge of third party payer requirements with excellent communication and customer service skills.

• A comprehensive knowledge of applicable insurance laws, and regulations related to Workers Compensation, No-fault, coordination of Benefits (COB), Medicare, Medicaid, Tri-care, Champva including CHP+ policies,and Third-Party-Liability (TPL) is required.

• Employee must have the ability to operate a calculation and a personal computer including keyboard skills.

• Working knowledge of PC applications in work processing (MS Word) and spreadsheet software (MS Excel) is required 70% at Basic Level.

• Must be detailed oriented with good organizational and critical thinking skills and have the ability to multi-task.

• Must be able to work independently without direct supervision.

• Working knowledge of CPT-4, ICD-9 and medical terminology required.

• Working knowledge of commercial insurance primary and secondary payors.

• Knowledge of workers compensation guidelines.

Preferred Qualifications:

• Work experience in medical billing and collections with working knowledge of HCFA 1500, UB92 forms and other billing forms preferred.

• Experience working within the Resolute/Epic in a healthcare environment preferred.

• Understanding of Kaisers membership system, Common Membership and the claims system, Qcare preferred.

• Understanding of the electronic insurance verification using passport processes preferred.

• Knowledge of eSummit Exempla system preferred.

COMPANY: KAISER

TITLE: PBS Insurance Verification Technician - CO

LOCATION: Denver, Colorado

REQNUMBER: 1262992

External 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.