Medical Insurance Data Clerk - Maui Health Systems
Primary Location Wailuku, Hawaii
Worker Location Onsite
Facility Maui Memorial Medical Center
Job Number 1327972 Date posted 01/13/2025
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Description:
Under direct supervision, researches, extracts, codes and enters patient demographics, charges and adjustments; verifies insurance benefits; performs final billing; refers claims to insurance area as necessary; researches and reconciles payments from insurance and self-pay; verifies account balances; initiates transfers if necessary.
Job Summary:
Under direct supervision, researches, extracts, codes and enters patient demographics, charges and adjustments; verifies insurance benefits; performs final billing; refers claims to insurance area as necessary; researches and reconciles payments from insurance and self-pay; verifies account balances; initiates transfers if necessary.
Essential Responsibilities:
- Prepares source documents for Health Plan/Non-Plan Self-Pay for entry of billing information.
- Reviews visit records, Ancillary Services and Emergency Room visit records; ensures source document includes essential information required for data entry (e.g. MR#, birthdate, address, group number, subscriber name, attending physician, date of service); researches missing information.
- Codes CDM number of services provided; adjusts fees according to health plan benefits; applies prevailing rates for non-health plan patients.
- Registers patient and guarantor in system; enters charges; verifies totals against source documents for all billable services, regardless of billing type.
- Enters additional charges to patient accounts form source documents prepared by insurance clerk; performs insurance benefits maintenance; verifies proration of insurance; performs final billing; refers claims to insurance area as necessary.
- Enters adjustments to patient accounts into computer from already prepared source documents.
- Researches payer remittances for posting; determines patient account and proper insurance company/plan; determines contractual adjustments appropriate for insurance company/plan if underpayment or overpayment; transfers unidentified payments to suspense account; refers to supervisor or proper insurance area.
- Posts remittances and contractual adjustments to patient account; performs accounts receivable transfer when necessary to show proper liability; verifies zero insurance balance after remittance posting; refers account to insurance area if necessary; initiates rebilling action if patient still bears liability after all insurance remittances received; verifies batch total of remittances posted or suspended.
- Batches and files source documents for all data entry; assigns batch number for input and computer reports; verifies number and total for data entered.
- Performs miscellaneous data entry as assigned (e.g. updating of patient information, CDM additions, statistical data entry).
- Operates standard office equipment; maintains files and office supplies as necessary.
- Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.
Basic Qualifications:
Experience
- Minimum one (1) year of data entry or related experience.
Education
- High school diploma or GED.
License, Certification, Registration
- N/A
Additional Requirements:
- 10-key by touch.
- Demonstrated knowledge of and skill in adaptability, decision making, customer service, oral communication, problem solving, systems thinking, teamwork, and written communication.
- Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.
Preferred Qualifications:
- Knowledge of CPT coding, accounts receivable, medical terminology and medical insurance benefits.
- Post high school coursework in medical terminology and bookkeeping.
Primary Location: Hawaii,Wailuku,Maui Mem. Wili Pa Loop Building
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: S03|AFSCME|UNAC-UHCP-UNHCEH
Job Level: Entry Level
Department: WILI PA - Pat. Financial Ops & Admin - 3601
Pay Range: $21.38 - $23.76 / hour
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
On-site: Work location is on-site (KP designated office, medical office building or hospital).
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
