OHS Claims Processor I

Under direct supervision, provides patient/visitor receptionist; check in and out; cash handling appointment scheduling; and other Occupational Health Services department at clerical duties as directed.  Obtains employer/carrier information for billing/reporting purposes; contact employer/carriers to obtain authorization for treatment or report status of claim.  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 account 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 administrator/carriers and employer/clients.  Must be able to provide status of claim; creates patient accounts and files; Input and maintain information on all appropriate systems as utilized by Kaiser Permanente.  Requires excellent interpersonal skills and ability to multitask in busy environment.

• Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.


• Answer and screen incoming phone calls or department.  Receives and filter messages to provider/clinicians/case managers/case coordinators through the Health Connect system and reply as appropriate.  Greet patients/visitors and determine nature of visit. Handles customer inquiries.  Assist patients in completing forms.  Request for internal/external records.  Create accounts in the KP internal systems.  Transfer charges to the appropriate KP Health Connect patient account.  Contact employer/carrier for authorization/notification of treatment; request medical chart for the OHS physician appointments or if necessary in order to compile accurate information for reporting purposes.


• Schedule appointment for workers comp patients at Fontana/Riverside Medical Centers and participating outlying clinics; Interact with internal departments as well as outside carriers/employers to schedule appointments or obtain information for completion of forms.  Make rounds to certain internal department to retrieve paperwork as necessary.


• Consolidate or corrects duplicate accounts by using appropriate system functions.  Enter account notes on patient cases.  Review subpoena request.  Review KP internal systems to ensure that duplicate visits are not captured.  Complete transfer of care form.  Clear designated Health Connect work queues daily.


• Handle physician master scheduling for OHS.


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


• Create and prepare file for further processing/billing purposes; filing as required.


• Type various documents as required in our current KP systems.


• Payment and collection for OHSS services as required.


• Create patient accounts; add/update notes in on-line computer system as applicable; coordinate file with proper bills/reports.


• Prepare office supply orders.


• Performs other duties as required.


• 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.  


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  • In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
  Basic Qualifications:

  
  

  Experience

  
  

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

  
  

  Education

  
  

  
  
  • High School Diploma or equivalent.
  
  

  
  

  License, Certification, Registration

  
  

  
  
  • N/A
  
  

  
  

  Additional Requirements:

  
  

  
  
  • 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 Claim Processing.
  
  
  • Cash handling experience.
  
  
  • 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 Equipment
  
  
  • Typewriter
  
  

  
  

  Preferred Qualifications:

  
  

  
  
  • N/A
  
  

  
  

  
  

  Notes:

  
  

  • Employee can be asked to float from Riverside to Wildomar Trail or Moreno Valley-Heacock.

  
  

  • Schedule to include rotating weekends, holidays and floating within the established seniority sections.