Patient Billing Resolution Rep-PFS, On-Call (Days)

Description : Job Summary :

This position is responsible for resolving North, South, and Out of Region customers billing issues / disputes within the collections call center and research environment.

Skills required include analyzing account data, research and verification utilizing multiple systems, multi tasking and communicating with internal and external customers.

Also, resolves outstanding receivables through direct payment, payment negotiation, bad debt write off, revenue reversals and agency assignment for Self-Pay accounts.

Essential Responsibilities :

• Handles high volumes of in-bound calls and meets established KP metrics and goals.
• Responds to incoming communications including correspondence, inquiries from patients, guarantors, third parties, attorneys and other KP facilities or departments regarding accounts.
• This includes timely response to grievances and other regulatory concerns.
• Follows-up and performs collection of outstanding balances on accounts.
• Makes recommendations to refer accounts to appropriate parties for issue resolution such as other Collection Teams, Member Services, MFA Unit, etc.
• Evaluates account status by utilizing manual information sources and / or KPHC work queues.
• Maintains accurate account information by updating accounts receivable systems and department databases.
• Gathers information and makes recommendations related to adjustments of uncollectible balances and processes account appropriately.
• Identifies credits balances and route accounts to appropriate work queues.
• Identifies and communicates suggestions for improving department processes, procedures and customer relations via the appropriate forums within Kaiser Permanente.
• Performs other duties as assigned.
• Complies with legal and ethical requirements to protect patient, employee and KFHP confidentiality.
• Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.
• Ensures compliance with applicable local, state, and / or federal laws and regulations, including organization policies and procedures.
• Note : Internal PFS candidates may have job advancement opportunities via the PFS Career Ladder, and should consult with their supervisor and / or manager.

Basic Qualifications : Experience

• Minimum 2 consecutive years customer service experience within the last four years.
• Minimum 2 consecutive years collector or biller experience within the last four years.
• The Basic Computer Literacy Assessment score must be current within one (1) year (contact Local HR Office for testing).

Must obtain passing score on the Basic Computer Literacy Assessment (passing score set at 75).

Education

• High school diploma and / or GED.
• Basic minimum required quals OR successful completion of the PFS Career Ladder curriculum that is mapped tot that position.

License, Certification, Registration

N / A

Additional Requirements :

• Knowledge of billing and collection rules, regulations and other pertinent payer specific requirements.
• Proficient with patient accounting and computerized collection systems and use Windows operating system and Microsoft Office Applications (WORD, EXCEL, etc.).
• Problem solving skills.
• Ability to read, write and perform mathematical computations at a high school level.
• Above average active listening, communication (verbal and written), and persuasion skills, along with exceptional customer service skills.
• Must be able to sit at a computer screen and keyboard for extended periods of time.
• Ability to lift 10 lbs.
• Ability to handle rapid and high incoming call volumes for extended periods of time and use a headset.
• Ability to work well in a team environment and within the Labor Management Partnership guidelines and effectively participate in Unit Based Teams.

Preferred Qualifications :

• Customer service experience in a call center environment preferred within a healthcare environment.
• Knowledge of all health care collections lines of business.
• Multi-lingual.
• AA degree in Business, or certification in insurance billing or collections issued by an accredited institution.
30+ days ago