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Administration, Clerical & Support

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Review Services Coordinator

Location: Renton, WA Job Number: 700982 Date posted: 06/11/2018
Description: The Review Services Coordinator is a critical role in adjudicating pre-authorization coverage requests for all types of services - medical and DME. The work environment is fast paced and at many times complex. Knowledge of health plan functions is required and include reading and interpreting contracts and coverage and understanding claims payment. This role includes handling a high volume of incoming calls from members and providers, managing multiple requests simultaneously and accurately and easily identifying requests that require a higher level of clinical review. This position must have a strong knowledge of medical terminology, CPT, HCPC and ICD coding as well as strong computer skills. This position requires that all CMS, State and Federal compliance and regulatory requirements be met.

Essential Responsibilities:
  • Adjudicate pre-authorization requests for all services - medical & DME. Determine urgency of request based on information provided. Enter & process selected patient medical information into the Referral Management System (RMS) to produce the authorization.
  • Receive and process incoming phone calls from members, providers and internal KFHPW departments.
  • Perfom and research complex issues related to authorization denials, delays and claims related issues. Ability to get to the root cause of an issue and provide a accurate, concise explanation to the member, provider and/or internal KFHPW department.
  • Other duties as assigned (eWatson, training, JIVA, Ring of Defense)


  • Basic Qualifications:
    Experience
  • Minimum two (2) years of health care experience with emphasis in health insurance including pre-authorizations, benefits, eligibility, and billing.
  • Minimum two (2) years of experience with on-line computer systems and Microsoft Office.
  • Minimum one (1) year of phone customer service experience.
    Education
  • High School Diploma/GED.
    License, Certification, Registration
  • Certificate of completion of medical terminology training by date of hire/transfer.


    Additional Requirements:
  • Medicare knowledge.
  • Computer skills in Windows environment, including MS Word and Excel and Kaiser Foundation Health Plan of Washington applications.
  • Communication and interpersonal skills.
  • Working knowledge of Health Plan benefits and policies and medical terminology.
  • Basic understanding of Medicare regulations, particularly those pertaining to the provision of Part B services.
  • Working with the public with emphasis on problem solving and conflict resolution.


    Preferred Qualifications:
  • Kaiser Foundation Health Plan of Washington (KFHPW) work experience.
  • Experience with health plan contracts & coverage.
  • Health plan claims experience.
  • Medical coding experience with ICD-9/10, CPT and HCPCS.
  • Some college courses preferred.



    Primary Location: Washington,Renton,Renton Administration - Rainier 2715 Naches Ave. 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: OPEIU Job Level: Individual Contributor Job Category: Administration, Clerical and Support Services Department: Review 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 Administration, Clerical & Support Services Careers

    Administration, Clerical & Support Services Careers

    From greeting callers and visitors and answering questions to coordinating schedules and arranging meetings, our administrative, clerical, and support teams consistently demonstrate extraordinary knowledge, skills, and abilities. They provide superior and culturally sensitive service to each other, our members, purchasers, contracted providers, and vendors.

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