Claims & Referral Processor II Adjudication
Full Time
Englewood, CO
$25.45 - $28.95 an hour
Posted
Job description
SEIU Local 105 - $25.45 - $28.95
“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."
Provides technical assistance to Claims Examiners. Participates in external and internal audits, provides training to new/current staff, and completes additional projects. Assist leadership by providing feedback on training and other assigned duties. Makes members/region and their needs a primary focus of one's actions; develops and sustains productive member/patient relationships. Actively seeks information to understand member/region circumstances, problems, expectations, and needs. Builds rapport and cooperative relationship with members/region. Considers how actions or plans will affect members; responds quickly to meet member/region needs and resolves problems.
Essential Responsibilities:
- This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
- For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills.
- Understand and apply county, state and federal regulations.
- 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.
- Provides assistance to prepare materials as needed to leads, supervisors and managers for external audits.
- Communicate problems and/or trends to leads and management.
- Work with claim systems and management to assign work
- Attend and actively participate in meetings at request of management
- Prepare HD claim submissions to ensure accuracy and timeliness
- Effectively communicate with staff and management
- Support the NCA training program by participating in training activities, answering claims related questions that staff raise, and serve as a subject matter expert relating to processes/procedures.
- May train as necessary
Other duties as assigned within department job functions.
Basic Qualifications:
Experience
- Minimum four (4) years of claims adjudication experience.
Education
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Basic PC skills
- Working knowledge of Microsoft Word
- Ability to do basic math (addition, subtraction, multiplication). Math assessment with Proficiency Level: (2.51 - 3.50)
- 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
- Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT). Proof of certification or passing score required.
- Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight
Preferred Qualifications:
- N/A
PrimaryLocation : Colorado,Englewood,Meridian - Englewood MSSA
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : C01|SEIU|Local 105
Job Level : Individual Contributor
Job Category : Insurance & Claims
Department : Englewood MSSA Claims - National Claims Service Org - 1608
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
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