OHS Claims Processor I (Bilingual)

Under direct supervision, Provides patient/visitor reception; check in and out; cash handling appointment scheduling; and other Occupational Health Services 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.

• 1. 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 oganizations philosophy of providing extraordinary customer relations and quality service as well as all other Kaiser Permanente Policy Procedures.
Basic Qualifications:

Experience

• Typing 35 wpm required.  All testing must be completed by the end of posting period.

• Minimum of one (1) year relevant clerical and customer service experience in Workers Compensation.  Successfully passed a medical terminology test.

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• Knowledge of Workers Compensation claims 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.

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• EQUIPMENT UTILIZED:

• Computer , Adding Machine, Fax Machine, Photocopier, Telephone, Typewriter

Education

• High school diploma/GED

License, Certification, Registration

• N/A

Additional Requirements:

- Bilingual (English/Spanish) Level I required.

Preferred Qualifications:

 

Notes:

- Must successfully have passed the bilingual test (within the last 12 months), or be active in the QBS program.