JOB SUMMARY:

In addition to the responsibilities listed below, this position may also be responsible for exercising judgment to process and resolve rejections and denials from insurance payers to ensure service costs are charged and pooling denied claim and underpayment information, and resolving or escalating complex workflow or build issues; overseeing and coaching the researching, coping, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services) while recommending process improvements; initiating quality reviews and education and coaching of staff for the verification and validation of insurance coverage discovery, coordination of benefits, applying insurance to a patient account; coaching of staff of patient account to ensure appropriate coverage; resolving coverage-related errors or disputes; partnering with vendors to ensure the coverage for underinsured and self-pay patients is completed in a timely manner; initiating quality reviews and education of the team is efficiently executing third party, workers compensation, and secondary coverage payments are received; using thorough knowledge of business practices to coach the team to negotiate payment plans to set terms of pay agreement, explaining what is owed, offering discounts, ensure quality and productivity standards are being met, and resolve escalations; using thorough knowledge of business practices to coach the team to providing customer service while explaining the application process, providing direction to the team to processing applications and disposition, follow policy regulations and provide MFA status, provide quality assurance and ensuring quality standards are being met; assuring alignment with government guidelines and internal policies; resolve escalations; provides coaching and ensuring the team efficiently collects cost-share at time of service or post-service collections based on system deposit, schedule, and payment collections; monitoring closure of cash drawers when needed; ensuring adherence and enforcing to SOX regulations; issuing a wide range of complex demands for payment of services provided; maintaining the workflow and coaching the team to manage a portfolio (e.g., negotiate, agree, monitor payment plans) to determine if agreements should be sustained or cancelled; ensuring the process completion of the enrollment of providers in Medicare, Medicaid, and workers compensation; ensuring teams quality of performance affecting payment posting and provides coaching for remediation; scheduling the work of others, setting work priorities, ensuring adherence and enforcing SOX regulations and removes barriers to completing task; reporting and escalating payment posting issues; coordinating the team to ensure the processing of credit cards and refunds by the staff are completed according to statutory timelines; assisting with research on simple and complex refund inquiries; approval of refund authority within FDA; coordinating CMS requests; identifying opportunities for root-cause prevention; reviewing the completion of processing bankruptcy, deceased, court decrees, and triage ROI requests in partnership with other groups; coordinating quality reviews, recommending improvements, and partnering across teams to escalate barriers and resolve issues.

MINIMUM QUALIFICATIONS:

• Minimum one (1) years of experience in a lead or leadership role with or without direct reports.
• Bachelors degree in health care administration, business administration, or related field. OR Minimum three (3) years of experience in data analytics, merchant services , clinic/hospital operations, merchant services, banking, health care billing and collections, or relevant experience.

ADDITIONAL REQUIREMENTS:

PrimaryLocation : Washington,Spokane,Admin. Center North, Spokane
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-WA-04|NUE|Non Union Employee
Job Level : Team Leader/Supervisor
Job Category : Business Operations
Department : Spokane Admin North - Govt/lns Collections - 1130
Travel : No
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

• Recommends developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides team members with feedback; and mentors and coaches to drive performance improvement. Pursues professional growth; provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Implements, adapts, and stays up to date with organizational change, challenges, feedback, best practices and processes. Fosters open dialogue, supports, mentors, engages, and motivates team members on collaboration. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope.
• Supervises and coordinates daily activities of designated work team or unit by monitoring the execution and completion of tactical action items and work assignments; ensures all policies and procedures are followed. Aligns team efforts and standards, and measures progress in achieving results; determines and carries out processes and methodologies; resolves escalated issues as appropriate. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; identifies and recommends improvement opportunities; influences teams to execute in alignment with operational objectives.
• Ensures the teams work is in compliance by: reviewing the teams work and delivering training to ensure they adhere to federal and state laws, and applicable compliance standards, and delivering monthly quality reports to leadership, and escalating unresolved issues to senior management.
• Ensures accurate patient accounts by: overseeing the management of inquires from providers, members, attorneys, and other insurance personnel to answer a billing questions.
• Facilitates the denial process by: ensuring the teams quality of performance affecting denials and provides feedback for remediation and overseeing the teams data analysis and partnership efforts when making recommendations while also performing follow-up and denial management activities related to the collections of outstanding self-pay and/or insurance balances and recommending accounts and performs necessary outreach to guarantors, insurance companies and attorneys to ensure timely, accurate payments.
• Ensures finances are completed accurately by: monitoring usage and ensuring proper use of expenditures for the team.
• Manages performance management initiatives by: widely applying strategies to monitor the teams performance metrics and provide coaching to ensure the teams work meets established performance levels and analyzes data and experiential information to generate a wide range of complex reports for relevant departments and medical centers to assess performance progress. aggregates information to oversee performance to enable decision making and confirming quality of the team to monitor effective vendor performance of collections, coding services, Medi-Cal, systems, coverage validation, income verification.
• Manages process management initiatives by: using knowledge of business field practices to coordinate and collaborate with operations managers, IT, Finance, and health plan managers to plan process improvement projects and identify business needs while also planning the work of others, with limited direction, to translate business needs into project requirements in partnership with others that are then used to develop project specifications and action plans.
• Manages project management initiatives by: supervises project execution and management efforts by helping team members implement with stakeholders within the team to ensure the project is successfully executed and project-based changes are implemented.
• Leads regulatory reporting by: sharing training resources and applying regulation standards to the teams work and making corrections, coordinating regulatory extracts while also supporting implementation of required changes.
• Manages systems management initiatives by: collecting the teams feedback, providing training, communication, and facilitating the review, validation of the build, and adoption of new systems updates for the team and escalating complex issues to management.
• Facilitates training delivery by: coordinating and delivering broad-based training to their teams based on policies, audit findings, and work curriculum.
• Facilitates training development by: using thorough knowledge of business practices to identify education and training requirements that reflect revenue cycle changes to coach the team and recommend strategic training content.