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Account Reconciliation Processor Job

Read the Account Reconciliation Processor (job description) to understand the position requirements.



    Researches follows up on all patient insurance credit balance accounts for all lines of business in order to resolve accounts to a zero balance provide excellent compliant client service to KP patients, institutional government payers including Medicare MediCal.
    Identifies reconciles accounts so that if necessary they can be escheated to state to comply with regulatory requirements.
    Reviews KP HealthConnect (EPIC) work queues or reports to define proper course of action for credit balance resolution by preparing or reversing adjustments, initiating refund requests, reversing charges requesting transfers, if applicable.
    Analyzes explanation of benefits, attorney, insurance other confidential documentation, including patient statements as part of account resolution.
    Discusses credit balances refunds with attorneys insurance adjusters who represent patients and/or institutional government payers, including Medicare MediCal, Follows up with written correspondence as needed with attorneys institutional payer representatives.
    Identifies trends root causes in undistributed payments recommends solutions to PFS management, NCAL SCAL Revenue Cycle management TPMG SCPMG management regulatory compliance staff, in order to prevent future occurrences ensure compliant actions by KP.
    Analyzes Explanation of Benefits (EOBs) remittance advices posts refund adjustments to appropriate accounts consistent with KP Policies PFS reimbursement guidelines contracts.
    Compiles documentation for submission to Accounts Payable that supports refund processing ensures compliant KP actions superior client service.
    Performs other related duties as assigned, including but not limited to special projects.
    Consistently supports compliance Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining privacy confidentiality of information, protecting assets of organization, acting with ethics integrity, reporting non-compliance adhering to applicable federal, state local laws regulations accreditation license requirement (if applicable) Kaiser Permanentes policies procedures.
      This is a repost of 214887. Basic minimum required quals OR successful completion of PFS Career Ladder curriculum that is mapped to position. There are three experience / education based pathways by which candidates can qualify for position:
      1. Minimum of one (1) year recent patient accounts receivable reconciliation experience handling both Hospital Professional Patient Accounting AND one (1) year of healthcare collector experience performing outbound insurance balance follow-up resolution (not just inbound calls), using knowledge of patient debit balances, credit balances, procedure codes, refund procedures, cash transactions experience reconciling accounts to a zero balance - OR -.
      2. In absence of health care experience, minimum qualifications are four (4) years of credit, collections full account reconciliation experience as a collector or credit analyst making outbound calls handling highly complex accounts high volumes of reconciliation collection issues that have multiple root causes solutions - OR -.
      3. Internal PFS SEIU-UHW member candidates may qualify via PFS Career Ladder should consult with their supervisor and/or manager. Internal candidates must have a minimum two (2) experience years using KP HealthConnect Resolute or meet substitution requirement above.
      High School Diploma or GED.
        Demonstrated experience reconciling accounts to a zero balance, including all debit credit balances, with a basic understanding of accounting transactions.
        Windows XP: Must obtain passing score on Windows XP assessment. The Windows XP assessment score must be current within one (1) year (contact Local HR Office for testing).
        Successfully pass 10 key by touch test with minimum passing score of 7,700 gross keystrokes per hour.
        Demonstrated Computer Agility (tested) which includes being proficient in PC Windows based environment an ability to use Word Excel formulas, sorting other common functions (minimum test score required).
        Being Able to effectively communicate account circumstances and/or root causes to ASU management PFS staff.
        Demonstrated knowledge of Federal Fair Debt Collections Act, HIPAA, NAIC.
        Demonstrated knowledge of reimbursement practices by all lines of business that PFS handles (e.g.,Medicare, MediCal, Commercial, Workers Compensation, Self Funded, etc.).
        Understanding of contractual allowances, capitation reimbursement, administrative adjustments basic medical terms.
        Strong interpersonal, verbal written communication skills.
        Being Able to perform basic mathematical computations succinctly describe analysis performed.
        Being Able to work well in a team environment within Labor Management Partnership guidelines effectively participate in Unit Based Teams.
        Being Able to sit for long period of time.
        Being Able to use general office equipment including telephone, fax, copier, etc. AA degree in business or certification in health or other insurance billing or collections issued by an accredited learning institution, preferred.
        SUBSTITUTION: BA or BS degree in another academic area that focuses on analysis or accounting, preferred.
        An ability to use Excel functions such as match, sumif, vlookup other data analysis spreadsheet functions as needed is preferred.


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