The Systems Specialist of Revenue Cycle provides end-user client support to business partners (i.e., KP HealthConnect, ePremis, Patient Business Services, KPIT, General Accounting, Claims Department, etc.) during revenue cycle impacted system implementation and/or new releases which includes system testing, issue identification and resolution, documentation, status reporting and risk mitigation. Participates significantly in system interpreting analyses and evaluates the effectiveness and accuracy of deliverables. Responsible for managing the paper and electronic claims process for Resolute Professional Billing, Resolute Hospital Billing and ePremis billing systems. Maintains workqueues and master files for various billing systems (i.e., Resolute, SPARCS, e-Premis). Will serve as the revenue cycle systems liaison with KP HealthConnect, Epic, ePremis, and other business partners to resolve complex electronic and paper claims related issues and assist in testing and validation of new system enhances and implementations related to claim and/or bill processing. Will maintain historical data files per KP and regulatory requirements. Will provide assistance and training to end-users on various computer system applications.
- Provide end-user client support to business partners (i.e., KP HealthConnect, ePremis, Patient Business Services, KPIT, General Accounting, Claims Department, etc.) during revenue cycle impacted system implementation and/or new releases which includes system testing, issue identification and resolution, documentation, status reporting and risk mitigation. Responsible for assisting with the stabilization of new informational systems that affect the revenue cycle (i.e. Epic Resolute Professional Billing and Hospital Billing, Diamond, PIMS, ePremis, etc.). Serve as the revenue cycle systems liaison for KP HealthConnect, Epic, ePremis, and other business partners as it pertains to the revenue cycle. Work collaboratively with business partners to resolve complex revenue cycle system issues.- Direct configuration activities in Epic System to resolve problems escalated to the RC Systems Optimization Department. Set up and test configuration to resolve complex modifications and requests from business partners throughout NW's Revenue Cycle Build. Build, maintain and update application WQ's to ensure data integrity.- Contribute to the development and maintenance of system education materials. Create written procedural documentation for system controls to assist in training and compliance. Create and maintain tools to effectively perform system audit functions. Providing education and/or training as needed when patterns of errors are identified, changes in systems occur, or when proactive measures are needed.- Maintain current knowledge and system skills. Perform other duties as required.
Experience- Minimum three (3) years of insurance billing experience in a medical, hospital, and/or insurance office setting.- Minimum three (3) years of experience working with and/or managing computer applications for end-users in a medical and/or financial area.Education- Bachelor's degree in health care administration, information systems, business, a health care professional, library science, or information resource management OR four (4) years of experience in a directly related field.- High School Diploma or General Education Development (GED) required.License, Certification, Registration- Obtain Epic proficiency in both Resolute Professional Billing and Resolute Hospital Billing Revenue Cycle sub-modules (i.e., Revenue Cycle, Charge Master, Collections, Payment Posting, etc.) within one (1) year after completion of required Epic courses.- Must maintain Epic proficient status per Epic requirements.
Additional Requirements:- Thorough understanding and familiarity with health care provider data and billing data/issues.- Demonstrate working knowledge of computer application in business settings.- Strong analytical and problem solving skills with experience in computerized business systems.- Thorough knowledge of health care benefits and insurance regulations.- Demonstrated understanding of medical insurance billing (i.e. CPT-4, ICD9CM and other coding and billing requirements) and medical collection rules.- Knowledge of Epic's Resolute Professional and/or Hospital billing modules or other large-scale clinician practice and/or hospital billing systems.- Knowledge of the following lines of business: Commercial, Coordination of Benefits, Medicare, Medicaid, Third Party Liability, Tricare, and Workers' Compensation- Excellent oral and written communication skills with ability to translate end-user needs into acceptable computer software applications.- Excellent customer service and project management skills.- Knowledge of basic accounting principles.
Preferred Qualifications:- Minimum three (3) years of experience at Kaiser Permanente.- Minimum two (2) years of experience using Epic's Resolute Professional and/or Hospital Billing modules.- Experience with decision support systems, data warehouse and/or management reporting.- Experience with Microsoft Office, including Access, Excel, Word, and PowerPoint.- Knowledge of large-scale clinician practice and hospital billing computer systems.- Knowledge of health plan membership, pharmacy and claims database systems.- Knowledge of research and analyses/design.- Knowledge of systems analysis.- Knowledge of HMO products and audit functions.- Knowledge of Crystal Reports.
TITLE: Revenue Cycle Systems Optimize Specialist
LOCATION: Portland, Oregon
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.