Kaiser Permanente Examiner Claims in Spokane, Washington
Process claims for care provided outside of the staff model by reviewing and interpreting the members individual benefits and verifying payment of the claim within the terms of the providers contract.
Processing the claim to make sure it is paying correctly. Taking correct co-pays, making sure provider billed correctly.
Maintenance of unreleased claims to insure timely payment. To continue to check pending batches on a regular basis checking for COB information, authorizations being answered, Dictionary issues.
Maintaining the inventory data base making sure that claims that are in a deficiency status are able to be adjudicated.
Call tracking-Making sure that claims are processed and information relayed back to Customer Service. Dictionary Issues-Claims that are not paying correctly or are coming up deficient are sent to the Dictionary Unit for verification. Auth Issues-Claim can not link to a auth that is present, but something in the authorization needs to be changed in order for claim to link. These are sent to the Coordinator who then sends to RMU.
Minimum one (1) year of claims or medical billing experience.
High School Diploma/GED.
License, Certification, Registration
Knowledge of medical terminology.
Communication and analytical skills.
Experience with CPT.4 and ICD 9 coding.
10 key 70 strokes per minute.
Typing 50 WPM.
Associate's degree in a related field.
TITLE: Examiner Claims
LOCATION: Spokane, 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.