[Hiring] On-Call Claims Authorization Processor @Kaiser Permanente
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Role Description
This role involves performing full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals.
ā¢ Ensures pre-authorizations are complete and include pertinent data related to medical services and care received.
ā¢ Uses knowledge of Service Agreements and benefits in various KP markets within the CO region.
ā¢ Actively seeks information to understand claims and authorizations.
ā¢ Builds rapport and cooperative relationships with internal departments to ensure processing.
This position requires compliance with all Kaiser Permanente quality, safety, and emergency policies and procedures.
ā¢ Demonstrates quality and effectiveness in work habits and clinical practice in every interaction.
ā¢ Ensures patient safety in the preparation and provisioning of care.
ā¢ Reports safety hazards, accidents, incidents, and unsafe working conditions promptly.
ā¢ Processes pre-payment authorizations using various systems including Macess, SharePoint, and Health Connect.
ā¢ Analyzes relevant data to determine approval or denial for member reimbursement requests.
ā¢ Partners with medical review to assess high dollar and over limit claims.
ā¢ Reviews daily queue production reports for Medicare and various Commercial plans.
ā¢ Handles appeals and escalated issues for members and providers.
ā¢ Participates in phone conferences with management regarding claims outcomes.
ā¢ Attends weekly meetings/calls regarding authorizations from CRC, mental health, and/or continuing care.
ā¢ Designs and delivers training sessions for CRC Referral Processors and new hires.
ā¢ Runs daily MACESS report and analyzes productivity metrics.
Qualifications
ā¢ Minimum of three (3) years of healthcare experience in an inpatient/outpatient setting required.
ā¢ Minimum of six (6) months of experience researching and processing medical claims required.
ā¢ Minimum of six (6) months of experience doing referral/authorization entry required.
ā¢ High school diploma OR General Education Equivalency (GED) required.
Requirements
ā¢ Thorough understanding of member claims and referral authorization processing.
ā¢ Knowledge of applicable insurance laws and regulations related to claims processing.
ā¢ Ability to read/interpret provider orders and apply medical coding procedures using CPT-4 and ICD-9.
ā¢ Understanding of medical terminology required.
ā¢ Knowledge of authorization roles for the entire Colorado region.
ā¢ Effective communication skills required.
ā¢ Personal computer terminal skills.
ā¢ Typing speed of 35 w.p.m with 5% or less error rate required.
ā¢ Demonstrated customer service skills and understanding of Kaiser Permanente customer needs.
Company Description
Apply Now
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Role Description
This role involves performing full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals.
ā¢ Ensures pre-authorizations are complete and include pertinent data related to medical services and care received.
ā¢ Uses knowledge of Service Agreements and benefits in various KP markets within the CO region.
ā¢ Actively seeks information to understand claims and authorizations.
ā¢ Builds rapport and cooperative relationships with internal departments to ensure processing.
This position requires compliance with all Kaiser Permanente quality, safety, and emergency policies and procedures.
ā¢ Demonstrates quality and effectiveness in work habits and clinical practice in every interaction.
ā¢ Ensures patient safety in the preparation and provisioning of care.
ā¢ Reports safety hazards, accidents, incidents, and unsafe working conditions promptly.
ā¢ Processes pre-payment authorizations using various systems including Macess, SharePoint, and Health Connect.
ā¢ Analyzes relevant data to determine approval or denial for member reimbursement requests.
ā¢ Partners with medical review to assess high dollar and over limit claims.
ā¢ Reviews daily queue production reports for Medicare and various Commercial plans.
ā¢ Handles appeals and escalated issues for members and providers.
ā¢ Participates in phone conferences with management regarding claims outcomes.
ā¢ Attends weekly meetings/calls regarding authorizations from CRC, mental health, and/or continuing care.
ā¢ Designs and delivers training sessions for CRC Referral Processors and new hires.
ā¢ Runs daily MACESS report and analyzes productivity metrics.
Qualifications
ā¢ Minimum of three (3) years of healthcare experience in an inpatient/outpatient setting required.
ā¢ Minimum of six (6) months of experience researching and processing medical claims required.
ā¢ Minimum of six (6) months of experience doing referral/authorization entry required.
ā¢ High school diploma OR General Education Equivalency (GED) required.
Requirements
ā¢ Thorough understanding of member claims and referral authorization processing.
ā¢ Knowledge of applicable insurance laws and regulations related to claims processing.
ā¢ Ability to read/interpret provider orders and apply medical coding procedures using CPT-4 and ICD-9.
ā¢ Understanding of medical terminology required.
ā¢ Knowledge of authorization roles for the entire Colorado region.
ā¢ Effective communication skills required.
ā¢ Personal computer terminal skills.
ā¢ Typing speed of 35 w.p.m with 5% or less error rate required.
ā¢ Demonstrated customer service skills and understanding of Kaiser Permanente customer needs.
Company Description
Apply Now
Apply Now