Medical Claims Research & Resolution Specialist

Kaiser Permanente; Denver (CO); On-site; USD 52,000 - 76,000; Full time

Job summary

Kaiser Permanente is seeking a claims analyst to assess and analyze inquiries related to medical claims, authorizations and adjustments. Under general supervision, you will apply knowledge of claim processing, contracts, and regulations to determine correct processing and potential adjustments.

Responsibilities include researching claims, documenting case summaries, coordinating with other departments, and applying findings to similar claims to improve upstream processing accuracy.

Qualifications

• Basic PC skills and ability to work with standard office software.
• Experience with medical claims processing in a health plan environment preferred.
• Strong knowledge of ICD-10 and CPT terminology.

Responsibilities

• Verify the intent of inquiries and ensure adherence to contracts and regulations.
• Locate information relevant to the claim using available resources.
• Determine how claims were processed and research denied claims.
• Make determinations for adjustments as warranted.
• Document clear case summaries for review.
• Take next steps to resolve inquiries and educate on process improvements.
• Apply findings to similar claims to improve upstream processing accuracy.
• Research Kaiser Permanente payment checks and classify the reason for returns.
• Other duties as assigned.

Skills

Basic PC skills

Customer service

Claims processing knowledge

Medical terminology

ICD-10/CPT knowledge

Problem solving

Microsoft Word

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

Kaiser Permanente is seeking a claims analyst to assess and analyze inquiries related to medical claims, authorizations and adjustments. Under general supervision, you will apply knowledge of claim processing, contracts, and regulations to determine correct processing and potential adjustments.

Responsibilities include researching claims, documenting case summaries, coordinating with other departments, and applying findings to similar claims to improve upstream processing accuracy.