OHS Claims Processor I

Description: Under direct supervision, Provides patient/visitor reception; check in and out; cash handling appointment scheduling and other Occupational Health Service's duties clerical duties as directed. Obtains employer/carrier information for billing/reporting purposes; contact employers/carriers to obtain authorization for treatment or report status of claims. Review of records to identify potential billing opportunities and transfer charges to appropriate account, if applicable. Enter pertinent claim information into KP internal computer systems. Ordering and photocopying medical records; temporarily cover other desk/functions due to vacation and workload fluctuations; clears designated Health Connect work queues daily, creates patient accounts to register patients and fills in the required KP computerized systems, provides personalized and professional patient/employer/carrier services. Individual must be customer service oriented. Extensive contact with members, non-members, physicians, third party administrators/carriers and employers/clients. Must be able to provide status of claim; create patient accounts and files; Input and maintain information on all appropriate systems as utilized by Kaiser Permanente. Requires excellent interpersonal skills and the ability to multitask in a busy environment.

Essential Functions:

Answer and screen incoming phone calls for the department.

Receives and filters messages to providers/clinicians/case managers/case coordinators through the Health Connect system and reply as appropriate.

Greet patients/visitors and determine nature of visit.

Handles customer inquires.

Assists patients in completing required forms.

Request for internal /external records.

Creates accounts in the KP internal systems.

Transfer charges to the appropriate KP Health Connect patient account.

Schedule appointments for workers' compensation patients.

Interact with internal/external customers to schedule appointments or obtain information.

Make rounds to certain internal departments to retrieve paperwork, as necessary.

Consolidate or corrects duplicate accounts by using appropriate system functions.

Enters account notes on patient cases.

Reviews subpoena requests.

Review KP internal systems to ensure that duplicate visits are not captured.

Complete transfer of care forms.

Clear designated Health Connect work queues daily.

Open and distribute mail to proper areas; match bills to reports and mail to carrier along with any other documentation as necessary.

Type various documentation as required in our current KP systems.

Prepare office supply orders.

Payment and collection for OHSS services, as required.

Performs other related duties as required to maintain efficient departmental operations.

Promotes, ensures and improves customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service as well as all other Kaiser Permanente Policy Procedures.

Pay Grade: 13

Basic Qualifications:

Minimum of one (1) year relevant clerical and customer service experience in Workers' Compensation.

Cash handling experience.

High school diploma/GED.

Typing 35 wpm required.

All testing must be completed by the end of posting period.

Successfully passed a medical terminology test.

Knowledge of Workers' Compensation claims Processing.

Ability to research, summarize and communicate clearly to the public, both verbally and in writing.

Ability to use computer to perform assigned duties.

Equipment Utilized: Computer, Adding Machine, Fax Machine, Photocopier, Telephone and Typewriter.

Preferred Qualifications:

QBS Level 1- Bilingual Spanish preferred

Notes:

This is an on call position, days and hours may vary according to departmental need

Primary Location: California,City of Industry,Crossroads Occupational Medicine 12801 Crossroads Scheduled Weekly Hours: 0 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Call-in/On-Call Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: United Healthcare Workers - West Job Level: Individual Contributor Job Category: Insurance / Claims Department: Occupational Medicine Travel: No

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.

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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

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