OHS Claims Processor II
Primary Location City of Industry, California
Worker Location Flexible
Facility Crossroads Medical Offices
Job Number 1258907 Date posted 04/22/2024
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Description:
Under general supervision prepares Doctors First Reports and supplemental reports, review charts, abstracts and obtains specialty authorizations. Identify billable services. Must be able to demonstrate the ability to work collaboratively with co-workers and supervisor and possess excellent organizational skills. Must be customer service oriented. Extensive contact with members, non-members, physicians and third party administrators/carriers, requires excellent interpersonal skills. Input and maintain information on all appropriate systems as utilized by Kaiser Permanente
Job Summary:
Under general supervision prepares Doctors First Reports and supplemental reports, review charts, abstracts and obtains specialty authorizations. Identify billable services. Must be able to demonstrate the ability to work collaboratively with co-workers and supervisor and possess excellent organizational skills. Must be customer service oriented. Extensive contact with members, non-members, physicians and third party administrators/carriers, requires excellent interpersonal skills. Input and maintain information on all appropriate systems as utilized by Kaiser Permanente
Essential Responsibilities:
- 1. Reviews patients medical records to locate and transpose the history, treatment and prognosis and other medical information relevant to reporting of the patients industrial condition. Ability to interpret and abstract source documents and transfer into appropriate reporting format. Checks for proper authorization, consults with treating physicians, obtains physicians signature and files reports. 2. Review of medical chart to investigate potential industrial cases including liens. Knowledge and experience required with client profiles and processing differences for non-member clients with regard to treatment. Data entry of relevant information into appropriate KP electronic systems. 3. Interviews patients and gathers information, contacts employers/carriers to obtain authorization for treatment. Schedules and/or assists with follow-up appointments in Occupational Health Services and specialty areas, reports status to employers, carriers and expedites needed referrals. 4. Audits all patients medical and hospital records, including outside charges and ancillary records. Audits include identification of secondary medical conditions which may require consultation with the treating physician. Accesses and screens KP systems to identify and process billable services provided/paid for by Kaiser. 5. Completes routinely required workers compensation employer/carrier forms. 6. Provides personalized and professional customer service. Occasionally provide back-up for OHS clerical duties. 7. Perform other duties as assigned. DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position and as such are not intended to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified.
Basic Qualifications:
Experience
- Typing 40 wpm.
- One year recent (within last 2 years); Workers Compensation claims processing, filing physicians reports and knowledge of the rules and regulations of Workers Compensation. Two years experience in the health care field required.
- EQUIPMENT UTILIZED: Computer Adding Machine Fax Machine Photocopier Telephone Typewriter
Education
- High school diploma OR General Education Diploma (GED) required.
License, Certification, Registration
- Medical Terminology Certification
Additional Requirements:
- N/A
Preferred Qualifications:
- N/A
Notes:
- This is an on call position, days and hours may vary.
Primary Location: California,City of Industry,Crossroads Medical Offices
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: B01|SEIU|Local 399
Job Level: Individual Contributor
Department: Regional Offices - Pasadena - Occupational Health-Reg Clin - 0806
Pay Range: $31.39 - $34.77 / 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: Yes, 10 % of the Time
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
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
