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Kaiser Permanente Careers

Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Patient Financial Services Follow-Up Collections Specialist

Location: Hyattsville, MD Additional Locations:
Job Number: 830747 Date posted: 01/14/2020
Description:
Performs follow-up and collections activities related to one or more of the following financial classes: self-pay, commercial insurance, Medicare, Worker's Compensation (WC), Third Party Liability (TPL).


Essential Functions:
- Performs follow-up and denial management activities related to the collections of outstanding self-pay and/or insurance balances.
- Researches accounts and performs necessary outreach to guarantors, insurance companies and attorneys to ensure timely, accurate payments.
- Resolves account issues including validating accuracy of guarantor statements, resubmitting claims, identifying information needed to correctly process claims and generally working through issues in order to collect payment as expediently as possible.
- Understands and complies with terms of managed care contracts and associated federal/state regulations related to billing and collections, coordination of benefits, and subrogation.
- Stays abreast of, and communicates changes in regulations pertaining to guarantor and/or insurance collections.
- Processes and resolves rejections and denials received from third party.
- Documents conversations and correspondence with patients guarantors, insurance representatives, attorneys and other internal/external customers in billing system.
- Receives and responds to incoming customer calls pertaining to billing inquiries and the collection of outstanding receivables.
- Offers payment arrangements to delinquent accounts in accordance with Patient Financial Services (PFS) guidelines.
- Assists in the development and implementation of policies and procedures for the PFS department, when appropriate.
- Reviews and responds to various forms of inquiries from Medicare, providers, members, patients, attorneys, customer service, provider relations, external insurance sources, and other internal customers.
- Manages case load and work queue volumes by following appropriate follow up time lines in accordance with PFS guidelines.
- Participates in the negotiation process for payment according to established departmental criteria, policies and procedures.
- Performs other duties as directed.
Basic Qualifications:
Experience
- Minimum three (3) years of experience researching and validating commercial primary insurance, health care billing and collections are required.
Education
- Associate's degree required, OR two (2) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
 
Additional Requirements:
- Demonstrated expertise in applicable subject matter, based on assigned production area is required.
- Experience in Microsoft NT, Word, Excel, and Access is required.


Preferred Qualifications:
- Minimum one (1) year of experience in customer service is preferred.
- Knowledge of Tapestry, Epic and TPL module is preferred.


- Prefers someone who understands the coordination of benefits of NAIC regulation and CMS
Primary Location: Maryland,Hyattsville,New Carrollton Administration 4000 Garden City Dr. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: Patient Financial Services Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

About QA, Ur & Case Management Careers

Careers In QA, Ur & Case Management

As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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