Kaiser Permanente Review Services Coordinator in Renton, Washington
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.
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)
POSITION IS PART OF THE REFERRAL MANAGEMENT UNIT AND JOB DUTIES VARY FROM
DESCRIPTION. MORE DETAILS WILL BE SHARED
IN A PHONE INTERVIEW.
- Basic Qualifications:
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.
- High School Diploma/GED.
License, Certification, Registration
- Certificate of completion of medical terminology training by date of hire/transfer.
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.
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.
TITLE: Review Services Coordinator
LOCATION: Renton, Washington
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.