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Accounting, Actuarial & Finance

Support the Bottom Line — and the Big Picture

Create the financial strategies that affect our patients, medical centers, and future. On this team, you'll provide the strategy recommendations that drive operational and process improvement, as well as face challenging opportunities to influence the future of health care.

Bill Quality Compliance Auditor I

Location: Pasadena, CA Job Number: 632984 Date posted: 09/16/2017
Description: Accountable for conducting various revenue cycle audits including, but not limited to: professional bills, hospital or facility bills, automated changes trigger functions, manual charge capture functions and any additional ad hoc assessments required by the Revenue Cycle Division of the Southern California Region. Responsible for preparation, assessment, and collection of audit findings. Service as subject matter expert on different levels of revenue cycle in accordance to regulatory requirements set forth by lines of business, state, and federal agencies.

Essential Functions:
  • Conduct bill/claim audits for professional and hospital claims (encompasses both CMS-1500 and UB04 claim formats).
  • Assess claims for various lines of business including, but not limited to: Medicare, MediCal, USDOL, State Workers' Compensation, Third Party Lien, Self-pay and DHMO.
  • Utilize expert knowledge of coding based on AMA's CPT, ICD-9-CM, HCPCS II, and OMFS guidelines.
  • Review claim fields in accordance with the Gold Standards set forth by each payer and mandated by the organization.
  • Applies expertise on different levels of regulations. These regulations vary by each line of business or payer. Follows specific state and/or federal regulations on billing and coding. Conducts post implementation assessments of various automated and manual charge captures.
  • Assess quality of various automated charge triggers as implemented, including, but not limited to: ambulatory E/M, radiology, laboratory and pathology services/charges.
  • Assess accuracy of various manual charge captures as implemented, including, but not limited to: infertility and non-KP facility professional charge captures.
  • Identifies effectiveness and opportunity for improvement on various revenue cycle processes, i.e. manual and/or systemic processes, pertaining to or affecting charge trigger functions.
  • Identifies, in detail, any conflicting and accurate data collected and reported that pertains to bill samples. Captures and reports audit findings to the highest quality.
  • Record audit findings in accordance with Quality Monitoring and Reporting unit's policies and procedure to ensure complete and consistent audit data capture.
  • Maintain timely capture and completion of audit data collection. Obtains all necessary documents/data that support bill data.
  • Partner with different Revenue Cycle departments to obtain key documents necessary to conduct assessments completely and effectively.
  • Access KP systems to supplement any paper documents available, including, but not limited to: mainframe systems such as OPAS, IM81, ARRS, and CPM; various KP HealthConnect Hyperspaces and modules; OHSM; ePremis; ImageSilo; ExpressBill; Crystal Reports; and any additional systems identified necessary. Provides subject matter expertise on billing and coding guidelines and regulations as required.
  • Conducts research of different regulations pertaining to any revenue cycle functions as required.
  • Support the department by providing subject matter knowledge on various billing, revenue cycle and coding topics.

  • This is a Repost of 598929.

    Basic Qualifications:
  • Minimum eight (8) years in healthcare with at least five (5) years experience in healthcare billing, coding and auditing of revenue cycle functions.
  • Bachelor's degree in finance/business or healthcare OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Developmen (GED) required.
    License, Certification, Registration
  • Certification as a Certified Professional Coder (CPC), Certified Coding Specialist-Professional (CCS-P) or Certified Coding Specialist (CCS) required.

    Additional Requirements:
  • Hands-on experience on billing, coding, medical chart documentation with demonstrated knowledge of compliance and risk management practices.
  • Must be able to work in a Labor/Management Partnership environment.

    Preferred Qualifications:
  • Minimum four (4) years of continuous experience coding under required certification preferred.
    Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Accounting, Finance and Actuarial Services Department: SCAL Revenue Cycle 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 Accounting, Finance, & Actuarial Careers

    Accounting Careers

    Members of our accounting team support corporate projects and lend insight to areas such as financial reporting, tax planning and preparation, and audit management. This team also includes our audit professionals, who partner with financial and operational groups across the organization to analyze budgets and streamline procedures.

    Finance Careers

    Supporting critical business functions such as financial services, national Medicare finance, strategic planning, auditing, and corporate finance, our finance professionals develop the strategies that enable us to meet our financial goals.

    Actuarial Careers

    Applying probability and statistics to the practical problems of insurance, our actuarial team performs a variety of duties, including calculating the cost of premiums and policy values, preparing statistical studies, and forecasting financial results.

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