[Hiring] On-Call Claims Authorization Processor @Kaiser Permanente

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves performing full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals. • Ensures pre-authorizations are complete and include pertinent data related to medical services and care received. • Uses knowledge of Service Agreements and benefits in various KP markets within the CO region. • Actively seeks information to understand claims and authorizations. • Builds rapport and cooperative relationships with internal departments to ensure processing. This position requires compliance with all Kaiser Permanente quality, safety, and emergency policies and procedures. • Demonstrates quality and effectiveness in work habits and clinical practice in every interaction. • Ensures patient safety in the preparation and provisioning of care. • Reports safety hazards, accidents, incidents, and unsafe working conditions promptly. • Processes pre-payment authorizations using various systems including Macess, SharePoint, and Health Connect. • Analyzes relevant data to determine approval or denial for member reimbursement requests. • Partners with medical review to assess high dollar and over limit claims. • Reviews daily queue production reports for Medicare and various Commercial plans. • Handles appeals and escalated issues for members and providers. • Participates in phone conferences with management regarding claims outcomes. • Attends weekly meetings/calls regarding authorizations from CRC, mental health, and/or continuing care. • Designs and delivers training sessions for CRC Referral Processors and new hires. • Runs daily MACESS report and analyzes productivity metrics. Qualifications • Minimum of three (3) years of healthcare experience in an inpatient/outpatient setting required. • Minimum of six (6) months of experience researching and processing medical claims required. • Minimum of six (6) months of experience doing referral/authorization entry required. • High school diploma OR General Education Equivalency (GED) required. Requirements • Thorough understanding of member claims and referral authorization processing. • Knowledge of applicable insurance laws and regulations related to claims processing. • Ability to read/interpret provider orders and apply medical coding procedures using CPT-4 and ICD-9. • Understanding of medical terminology required. • Knowledge of authorization roles for the entire Colorado region. • Effective communication skills required. • Personal computer terminal skills. • Typing speed of 35 w.p.m with 5% or less error rate required. • Demonstrated customer service skills and understanding of Kaiser Permanente customer needs. Company Description Apply tot his job Apply To this Job