Staff Position

Registered Nurse (RN) - Med Surg
Kaiser Permanente
Portland, OR
5x8 hrs, Days

$105K-136K/year
Posted Today

Overview

  • Shift Breakdown5x8 hrs
  • ShiftDays

Pay

Estimated pay
$105K-136K/year

Qualifications

The employer will review your Vivian profile and compare it against the job qualifications listed below.
Required
    Other
  • Eligible to work in US

Description

Job Summary:
Review claims for services obtained outside of Kaiser facilities for compliance with health plan service agreement with members; identifies health plan claims with potential quality of care issues, continuity of care problems, or access issues at medical facilities; and audits hospital billings on site at non-plan provider facilities and negotiates successful resolution of claim.

Essential Responsibilities:

  • Provides clinical expertise to other departments such as Workers Compensation, CSA/MSA outside case management in areas related to hospital and physician billing practices and cost containment activities.

  • Works with legal department when indicated to resolve payment disputes.

  • Serves as a consultant to CSA Continuing Care teams and case managers on issues on non-pricing, billing problems, procedures and benefit compliance issues. Identifies opportunities for cost containment. Works with regulatory compliance for review of benefit.

  • Responsible for review ICD-9, CPT codes, medical records, UB-92 and HCFA forms and Kaiser Permanente internal systems (OTRS, Advice call logs). Determines if bills are payable or if additional informatio is needed, identification of potential fraud issues.

  • Works with PRS staff as a resource for decision-making and medical terminology.

  • Plans and organizes daily work to meet compliance timeframes. Provides feedback to manager to ensure work is within compliance.

  • Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization.

  • Acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.
Basic Qualifications:
Experience

  • Minimum five (5) years of clinical experience.


Education

  • Graduate of an accredited nursing program required.

  • High School Diploma or General Education Development (GED) required.


License, Certification, Registration

  • N/A


Additional Requirements:

  • Must have demonstrated ability to work independently and make quick decisions with a high degree of competency utilzing multiple sources of information.

  • Compentency in Microsoft Suites (Excel, Access, PowerPoint), excellent ability with proprietary, mainframe processing systems and KP technologies.

  • Demonstrates strong understanding of medical terminology, ICD-9 coding, CPT coding principles.

  • Must be able to work in a Labor/Management Partnership environment.


Preferred Qualifications:

  • Minimum five (5) years of clinical experience in critical care preferred.

  • The ability to make timely, sound decisions, and to act independently and negotiate successful resolution in difficult situations preferred.

  • Certification or course completion certificates in coding preferred.

  • Familiarity with ICD-9 and CPT coding, hospital billing practices preferred.

  • Bachelors degree preferred, OR four (4) years of experience in a directly related field..


Notes:



  • Must have UM or Coding Experience

Kaiser Permanente Job ID #1319799. Posted job title: Medical Audit Coordinator, Registered Nurse Specialist

Employer

Kaiser Permanente

3.7rating(3 reviews)
Compensation
3.0rating
Culture
3.0rating
Work Environment
3.0rating
5.0rating
Anonymous
Anonymous
Monitor Technician (Allied Health Professional)
Review of Kaiser Permanente on Oct 3, 2024
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About
At the heart of health care, you'll find Kaiser Permanente. As the nations leading not-for-profit, integrated health plan, we make a difference in the lives of members, patients, and communities across the country.With 39 hospitals and more than 734 locations in eight states and the District of Columbia, we proudly serve more than 12.7 million members from coast to coast. Whether you choose to join a hospital in the Northwest, a clinic in Southern California, or a medical office in the Mid-Atlantic, we have many opportunities for you to shape the future of care.Our teams are empowered to advance impactful and extraordinary care for all by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement. This covers more than our members and our employees; it also reaches far into our communities. Together, we're proudly working as one for a healthier today and tomorrow.
Response timewithin a day
Staff jobs$21–148/hour
Local contracts$21–148/hour
Per Diem / PRN roles$21–148/hour
Jobs on Vivian1
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Portland, OR

About

Portland is a colorful, eclectic city in the Pacific Northwest and the largest city in Oregon. It sits on the Willamette and Columbia Rivers, with snowcapped Mt. Hood looming in the distance, offering panoramic views. You get the best of all worlds in Portland, a thriving city with fantastic restaurants and coffee shops, plus lots of accessible nature nearby. Check out the Japanese Garden and Powell’s City of Books, and don’t forget to grab an iconic pink box of donuts at Voodoo Doughnut. If you’re feeling adventurous, take a day trip to visit some of the many mossy waterfalls in the Columbia River Gorge or hike around Mt. Hood National Forest for a close-up view of the enormous stratovolcano.

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