Patient Access Representative

2 days ago


Seattle, Washington, United States Kaiser Permanente Full time
Job Summary:

We are seeking a highly skilled and detail-oriented Patient Access Representative to join our team at Kaiser Permanente. As a Patient Access Representative, you will be responsible for performing general patient access and registration duties, including answering telephones, making appointments, processing referrals, and verifying patient demographics and insurance coverage.

You will also be responsible for performing general patient account management duties, such as obtaining prior authorization for services, processing items in the appropriate work queues, and entering service capture data. Additionally, you will ensure that patient accounts and coverage structures meet Kaiser Permanente standards and billing requirements of various payors.

Key Responsibilities:
  • Answer phones and respond to patient inquiries
  • Make appointments and schedule patient visits
  • Complete accurate patient registration, including verification of patient demographics and payor coverage
  • Perform check-in, check-out, admit, and discharge tasks
  • Build and maintain appointing templates
  • Communicate with patients via multiple channels
  • Process internal and external referrals
  • Confirm and set up payor coverage structures
  • Obtain prior authorization for services
  • Process items in the patient, claim edit, and charge review work queues
  • Act as liaison to Patient Financial Services and the Health Plan
  • Communicate with external government payors and employers, as necessary
  • Perform manual service capture and data entry
  • Act as liaison to Health Information Management Coding Specialist for facility-specific coding issues
  • Apply account review criteria and billing guidelines in preparation for off-site billing of professional services
  • Provide fee estimates for KP services
  • Assist patients with billing questions
Requirements:
  • Minimum one (1) year of experience in a business office within a medical care delivery, hospital, insurance, or large contact center environment
  • Minimum two (2) years of experience providing excellent customer service in a fast-paced environment
  • High School Diploma or General Education Development (GED) required
  • Basic PC skills in MS Windows environment, 10-key, and typing (35 WPM)
  • Customer service skills, the ability to effectively communicate with a diverse customer base, and strong organizational skills
Preferred Qualifications:
  • Three (3) years of additional experience in a patient care setting
  • Use of Epic Cadence/Prelude/Resolute or other patient scheduling and accounting systems
  • Understanding of Kaiser Permanente billing protocols and cash posting systems
  • Familiar with medical terminology
  • Knowledge of delivery system business operations processes, including appointing, account intake and verification, cashiering, financial interviewing, referral processing, and data entry
  • Working knowledge of healthcare insurance practices and billing
  • Knowledge of healthcare payer/insurer types, including state and federal workers' compensation, commercial, subrogation, self-insured, Medicare (CMS), and Medicaid (DSHS)
  • Understanding of Kaiser Permanente insurance products and benefits
  • Proven ability to establish credibility and respect with patients
  • Proven ability to problem solve and take initiative
  • Ability to provide feedback and education to other staff regarding correct procedures
  • Six (6) months experience in processing various types of billing, including workers' compensation, subrogation, coordination of benefits, and private/self-pay


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