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Posted: Saturday, November 4, 2017 11:37 PM

Description: DescriptionThe Review Services Coordinator is a critical role in adjudicating pre-authorization coverage requests for all types of services - medical and DME. The work environment is fast paced and at many times complex. Knowledge of health plan functions is required and include reading and interpreting contracts and coverage and understanding claims payment. This role includes handling a high volume of incoming calls from members and providers, managing multiple requests simultaneously and accurately and easily identifying requests that require a higher level of clinical review. This position must have a strong knowledge of medical terminology, CPT, HCPC and ICD coding as well as strong computer skills. This position requires that all CMS, State and Federal compliance and regulatory requirements be met.


Minimum Education Requirements
High School Diploma/GED

Preferred Education
Some College Some college courses preferred.

Minimum Knowledge/Skills Requirements
Intermediate Computer skills, medical terminology, Medicare and strong communication skills. Computer skills in Windows environment, including MS Word and Excel and Group Health applications. Communication and interpersonal skills. Working knowledge of Health Plan benefits and policies and medical terminology. Basic understanding of Medicare regulations, particularly those pertaining to the provision of Part B services.

Preferred Knowledge/Skills

Minimum Experience Requirements
2 years healthcare experience with emphasis in health insurance including Pre authorizations, benefits and eligibility, billing. Working with the public with emphasis on problem solving and conflict resolution. 2 years experience with on-line computer systems and Microsoft Office. Medical terminology is required.
1 year Phone customer service experience.

Preferred Experience
Kaiser Permanente work experience. Experience with Health Plan contracts & coverage.
Health Plan claims experience. Medical Coding experience with ICD-9/10, CPT and HCPCS.

Minimum License/Certifications Requirements
At time of hire Certificate of completion of medical terminology training

Preferred License/Certifications
None Required

Kaiser Permanente is an Equal Opportunity Employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, marital status, age, sexual orientation, gender identity or expression, or any other legally protected status.

Job Type: Standard
Employee Status: Regular
Job Level: Individual Contributor
Job Category: Insurance & Billing
Travel: No
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• Location: Renton, Seattle

• Post ID: 57785587 seattle is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017