Description

-May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.

Job Summary:

Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems.

Essential Responsibilities:

• For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills.
• Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed.
• Proactively communicate with internal departments as appropriate to resolve claims issues promptly.
• Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes.
• Proactively communicate with internal departments as appropriate to resolve claims issues promptly.
• Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits.
• Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations.
• Other duties as assigned within department job functions.

Basic Qualifications:

Experience

• Minimum three (3) years of claims adjudication experience required.

Education

• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements:

• Customer service experience.
• Basic PC skills required.
• Working knowledge of Microsoft Word.
• Ability to work in a in a Labor Management Partnership environment.
• Ability to understand and meet customer needs in a claims setting.
• Ability to apply procedures, practices and methods used in claims processing.
• Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight.

Preferred Qualifications:

• N/A

Primary Location: Colorado,Denver,Regional Office - Colorado
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: C01|SEIU|Local 105
Job Level: Individual Contributor
Department: Englewood MSSA Claims - National Claims Service Org - 0315
Pay Range: $29.78 - $40.56 / hour Travel: No Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Requisition #: 1412309

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