the smart solution for Pasadena jobs

Billing Qual Compliance Auditor II

Company: Kaiser Permanente
Location: Pasadena
Posted on: January 13, 2019

Job Description:

Description: Accountable for conducting various revenue cycle audits including, but not limited to, professional bills, hospital or facility bills, automated charge trigger functions, manual charge capture functions, and any additional ad hoc assessments required by the Revenue Cycle Division of the Southern California Region. Responsible for the preparation, the assessment, and the collection of audit findings. Serves as subject matter expert on different levels of revenue cycle in accordance to regulatory requirements set forth by lines of business, state, and federal agencies and as needed, may prepare and deliver training to the Professional Service Coders and other Revenue Cycle personnel for improvement outcomes. Essential Responsibilities: Conducts bill/claim audits for professional and hospital claims (encompasses both CMS-1500 and UB04 claim formats). Assesses claims for various lines of business including, but not limited to, Medicare, MediCal, USDOL, State Workers' Compensation, Third Party Lien, Self-pay, and DHMO. Utilizes expert knowledge of coding based on AMA's CPT, ICD-9-CM, HCPCS II, and OMFS guidelines. Reviews claim fields in accordance with the Gold Standards set forth by each payer and mandated by the organization. Applies expertise on different levels of regulations. These regulations vary by each line of business or payer. Follows specific state and/or federal regulations on billing and coding. Conducts pre and post implementation assessments of various automated and manual charge captures. Assesses quality of various automated charge triggers as implemented. This includes, but not limited to, ambulatory E/M, radiology, laboratory, and pathology services/charges. Assesses accuracy of various manual charge captures as implemented. This includes, but not limited to, infertility and non-KP facility professional charge captures. Identifies effectiveness and opportunity for improvement on various revenue cycle processes, i.e. manual and/or systemic processes, pertaining to or affecting charge trigger functions. Identifies, in detail, any conflicting and accurate data collected and reported that pertains to bill samples. Captures and reports audit findings to the highest quality. Records audit findings in accordance with Quality Monitoring and Reporting unit's policies and procedure to ensure complete and consistent audit data capture. Maintains timely capture and completion of audit data collection. Obtains all necessary documents/data that support bill data. Partners with different Revenue Cycle departments to obtain key documents necessary to conduct assessments completely and effectively. Accesses various KP systems to supplement any paper documents available. This includes, but not limited to, various mainframe systems such as OPAS, IM81, ARRS, and CPM; various KP HealthConnect Hyperspaces and modules; OHSM; ePremis; ImageSilo; ExpressBill; Crystal Reports; and any additional systems identified to be necessary. Provides subject matter expertise on billing and coding guidelines and regulations as required by the department. Conducts research of different regulations pertaining to any revenue cycle functions as required. Supports the department by providing subject matter knowledge on various billing, revenue cycle, and coding topics. As needed, may develop and present training curricula to Professional Coders and other Revenue Cycle personnel for improvement outcomes. Basic Qualifications: Experience Minimum eight (8) years of experience in healthcare with at least five (5) years experience in healthcare billing, coding, and auditing of revenue cycle functions. Education Bachelor's degree in finance/business or healthcare, OR four (4) years of experience in a directly related field. High School Diploma or General Education Development (GED) required. License, Certification, Registration Certification as Certified Professional Coder (CPC) OR Certified Coding Specialist- Professional (CCS-P), AND Certified Coding Specialist (CCS) - Hospital/Facility. Additional Requirements: Hands-on experience on billing, coding, medical chart documentation with demonstrated knowledge of compliance and risk management practices. Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications: Training experience of Revenue Cycle functions. Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Accounting, Finance and Actuarial Services Department: SCAL Revenue Cycle Travel: No Click here for additional requirements > SDL2017

Keywords: Kaiser Permanente, Pasadena , Billing Qual Compliance Auditor II, Accounting, Auditing , Pasadena, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Accounting, Auditing Jobs

Senior Associate - IT Audit and Advisory / Cyber Security
Description: Candidates must currently or recently have been employed with a Big-4 or national CPA / Consulting firm specializing in IT Audit / IT Cyber Security projects We are a specialized boutique consulting (more...)
Company: Cameron Craig Group
Location: Woodland Hills
Posted on: 01/19/2019

TRES Server PT - SLS Hotel, a Luxury Collection Hotel, Beverly Hills (1800335M)
Description: Heres To Your Journey with The Luxury Collection The Luxury Collection is a glittering ensemble of locally authentic hotels and resorts from around the world. Our hotel teams curate the worlds most enriching (more...)
Company: Marriott International, Inc.
Location: Long Beach
Posted on: 01/19/2019

Billing Clerk
Description: Los Angeles office of a prestigious law firm has an opening in its Accounting Department for a Billing Clerk. This is a full-time, contracted
Company: Busby Park Recruiting LLC
Location: Los Angeles
Posted on: 01/19/2019

First Year Tax Professional
Description: First Year Tax Professional Seeking seasonal Tax Preparers who want to grow their career and be a part of our network of expert professionals who enjoy serving clients with diverse tax needs. We offer (more...)
Company: H&R BLOCK
Location: Lake Forest
Posted on: 01/19/2019

Director of Training & Financial Coaching
Description: FreeFrom is looking for a deeply committed and dynamic Director of Training Financial Coaching to join our team. This individual will be responsible for executing and growing our financial capacity (more...)
Company: Non Profit Organization
Location: Los Angeles
Posted on: 01/19/2019

Bazaar Regalo Supervisor (Retail) - SLS Hotel, a Luxury Collection Hotel, Beverly Hills (17002IUT)
Description: Heres To Your Journey with The Luxury Collection The Luxury Collection is one of Marriott Internationals 30 renowned hotel brands. As the worlds leading Hospitality Company, we offer unmatched opportunities (more...)
Company: Marriott
Location: Long Beach
Posted on: 01/19/2019

Current College Students - Venture Capital / Growth Equity Internship - Summer 2019
Description: Who We're Looking For: br br Full-time summer interns to work directly with our investors to help source deals
Company: Anthos Capital
Location: Santa Monica
Posted on: 01/19/2019

Billing Clerk
Description: Job Responsibilities br br q Update Fairs Billing Database prices, flight master, etc. . br q Prepare invoices within 3 calendar days of the end of each customer's billing cycle. br q Resolve (more...)
Company: Flying Food Group, Inc.
Location: Los Angeles
Posted on: 01/19/2019

Corporate Controller
Description: Position: Corporate Controller Reporting To: CFO Salary: Consistent with experience Job Type: Full-time Location: Ontario, CA General Description: We are looking for a talented and hungry Corporate Controller (more...)
Location: Ontario
Posted on: 01/19/2019

Operational Business Analyst
Description: Overall Responsibility:Supports the CFO and corporate executives with operational analysis, corporate planning and strategic initiatives. This position contributes to a wide range of projects, including (more...)
Company: Atlantic Pacific Group, Inc.
Location: Santa Monica
Posted on: 01/19/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Pasadena RSS job feeds