Kaiser Permanente Quality Auditor, Patient Financial Services in Portland, Oregon

Coordinate between all Vendors and KPNW, act as liaison to ensure accurate reconciliation of files exchanged and invoiced between all entities. Performs and maintains knowledge of and assures departmental compliance with Kaiser Permanente's Sarbanes Oxley (SOX) controls as pertains to business office departmental policies, procedures and applicable regulatory requirements. Responds appropriately to observed fraud and abuse. Ensures accurate and timely completion of SOX and Non-SOX controls and other projects on an ongoing basis. Maintain and support a culture of compliance, ethics and integrity. Maintains knowledge of department policies and procedures and performs in accordance with applicable regulatory and internal requirements. Performs quality reviews of all PFS staff processes. Provides staff training and education as they relate to PFS business when appropriate. Provides management with audit findings and meets with leadership to develop policies and controls to support accurate billing and reimbursement. Process and resolve CIDARS requests.

Essential Functions:

  • Act as a liaison between PFS and all its Vendors. Responsible for Vendor AR and all their performances. Research and perform timely follow-up on accounts/files/invoices by conducting routine reconciliation processes. Investigate and correlate information from multiple sources. Coordinate all issues with Vendor. Able to read and understand all reports received from Vendor. Verify and research discrepancies and data received from Vendor and prepare financial reports for PFS and General Accounting department to that end. Be available to the Vendor leadership for questions regarding KPNW transfers and invoices. Represent Kaiser PFS in cross-departmental meetings when appropriate. Attend and assist with leading all Vendor meetings. Work closely with various business partners to ensure collaborative, productive working relationships.- Conduct audits of claims, bill statements, adjustments, refunds, credits, ePremis and etc. for timelines, appropriateness and quality. Validate that all data elements are accurate in accordance with the SOX and Non-SOX control being addressed to ensure that the PFS dept. complies with the SOX and Non-SOX requirements and/or conforms to regulatory guidelines and internal controls. Perform monthly Quality audits in coordination with the PFS Supervisors. Process and resolve CIDARS requests in an appropriate, effective and timely manner.- Analyze results and identify patterns, trends and variations in billing practices and make recommendations for improvement. Recommend workaround processes to meet immediate business needs while working with management to develop long term solutions. Meet with leadership to develop policies and controls to support accurate and timely billing. Provide consultation to other departments on billing clarity and relevance of billing to ensure the efficiency and productivity of the billing process. Maintain positive relationships with internal/external business partners and staff.- Contribute to the development and maintenance of billing education materials. Create written procedural documentation for SOX and Non-SOX controls to assist in training and compliance. Create and maintain tools to effectively perform audit functions. Provide education and/or training, when needed, if patterns of errors are identified, changes in billing or billing policy occur, or when proactive measures are needed.- Maintain adept and accurate knowledge of Patient FinancialServices SOX and Non-SOX controls. Maintain current billing knowledge and skills.- Perform other duties as requested.

Basic Qualifications:Experience

  • Minimum four (4) years of prior insurance billing experience in a revenue cycle related position.

  • Minimum three (3) years of general office experience with a complex on-line system.

  • Minimum one (1) year of experience in medical terminology.

  • Extensive computer and telephone experience.

Education- High School Diploma or General Education Development (GED) required.License, Certification, Registration- N/A

Additional Requirements:

  • Working knowledge of Excel and other business software.

  • Type/keyboard 30 wpm.

  • Basic knowledge of all aspects of UB 04 and CMS 1500 fields and requirements.

  • Basic knowledge of standard billing codes.

  • Basic knowledge of state and federal insurance regulations.

  • Basic knowledge of accounting principles.

  • Accuracy with numbers.

  • Excellent verbal and written communication skills.

  • Problem solving, listening and conflict resolution skills.

  • Detail oriented with organizational skills which involve the ability to prioritize and manage workflow, to produce high quality work, to work independently with minimal supervision and use good judgment.

Preferred Qualifications:- Minimum six (6) years of billing/collections experience in a Kaiser Permanente revenue cycle related position.

  • Minimum one (1) year of auditing experience in a complex healthcare system.

  • Minimum three (3) years of advanced experience with Microsoft Office, including Access, Excel, Word and PowerPoint.

  • Minimum three (3) years of experience in medical terminology and coding guidelines.

  • Minimum one (1) year experience working with Vendors in a Healthcare environment.

  • Data entry experience.

  • Bachelor's degree in business administration, finance, health administration or other related field.

  • Knowledge of Kaiser Permanente Health Plan coverage and benefits.

  • Knowledge of Kaiser Permanente computer systems and applications.

  • Knowledge of Kaiser Permanente organization policies and procedures.

  • Knowledge of CMS on-line guidelines.

  • Knowledge of Kaiser Permanente Accounts Receivable systems.

  • Ability to quickly analyze and develop solutions to complex issues.

  • Knowledge of billing requirements, coverage and benefits for private health insurers, federal and state agencies, CMS Medicaid and Medicare.

  • Knowledge of Fair Debt Collection Practice Act for Federal, State, and Regional laws.

  • Knowledge of State, Federal, and CMS agencies.

  • Excellent organization skills.

  • Knowledge of government and non-government EOB reconciliation.

  • Knowledge and application of medical terminology, Revenue codes and/or CPT-4, HCPCS and ICD-9CM (10) coding.


TITLE: Quality Auditor, Patient Financial Services

LOCATION: Portland, Oregon


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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.