Claims Processor
Primary Location Downey, California
Schedule Full-time
Shift Day
Job Number 1242436
Date Posted 11/12/2025
Job Summary:
Under general supervision provides patient/visitor reception, obtains employer and carrier information for billing, prepares Doctors First Reports of Injury, identifies appropriate ICD-9 codes, prepares and distributes supplemental and medical/legal reports, creates patient accounts and charts. 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.
Essential Responsibilities:
- Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.
- Reviews patients medical records to locate the history, treatment, prognosis and other medical information relevant to reporting of the patients condition. For Workers Compensation claims, processing may complete Doctors First Report of work injury, check for proper authorization, obtain physicians signature and file report within the five day time limit pursuant to California Labor Code; at periodic intervals during patients continuing treatment, but no less than each 45 days, review patient medical records and prepare narrative style medical progress report describing patients current complaints, treatment, time off, work orders, light duty and other medical information relevant to the patients industrial claim; consults with treating physician as necessary.
- Creates and registers patient account on automated billing system, inputting patient and employer demographic data to prepare account for billing; enters account notes when account has previously been established at another medical center; consolidates or corrects duplicate accounts by using appropriate on-line system functions; requires knowledge of automated billing system .
- Interviews patient and gathers information, contacts employers/carriers to obtain authorization for treatment. Schedules follow-up appointments reports status to employers/carriers, and expedites needed referrals as directed.
- Audits all patients medical and hospital records, including ambulance and pharmacy records, accesses and screens systems to identify industrial services paid for by Kaiser for rebilling to the patients employer or workers compensation insurance carrier; requires knowledge of medical terminology, CPT procedure codes, anatomy and physiology to identify all billable services, including secondary medical conditions directly or indirectly related to the principle industrial condition being claimed or litigated by the patient; consults with treating physician on complex cases; decisions made affect revenue.
- Selects ICD diagnostic Code(s) accurately describing the patients diagnoses, symptoms, conditions, problems, complaints or other reasons for the outpatient visit a documented in the patients medical records; consults with treating physician on complex cases or if outpatient records are undocumented; requires thorough knowledge of ICD Coding.
- Provide patient and telephone reception, check in/out, appointment scheduling and other department clerical duties as directed. Verifies eligibility, creates files, collects forms, and checks for legibility and completeness. Prepares schedules and provides personalized and professional patient/member service.
- Establishes and maintains courteous and cooperative relations with the public, patients and other personnel.
- May perform other duties as required.
- Determine eligible coverage and add to patient account in correct filing order. Terminate any ineffective coverage
- Verify account coverages have been updated by the system; if coverage has not been updated place stop bill on accounts and route to appropriate work queue or complete account correction Correct charges and errors for resubmission of claims
- Correct clearinghouse/payer errors
- Work designated HealthConnect work queues as assigned.
- Assume other activities and responsibilities from time to time as directed.
Primary Location: California,Downey,Downey Boeing - Independence Park
Scheduled Weekly Hours: 40
Shift: Day
Workdays: m-f
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: B01|SEIU|Local 399
Job Level: Individual Contributor
Department: Independence Park - NCA Ongoing Operating Exp - 0315
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's 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 licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
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