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Accounting, Actuarial & Finance

Support the Bottom Line — and the Big Picture

Create the financial strategies that affect our patients, medical centers, and future. On this team, you'll provide the strategy recommendations that drive operational and process improvement, as well as face challenging opportunities to influence the future of health care.

Industrial Report Billing - Grade 6

Location: Redwood City, CA Job Number: 697345 Date posted: 07/11/2018
Description: Abstract the required information from medical records for completion of Doctor-s First Reports of Industrial Injury or Illness, Primary Treating Physician Progress Reports and other medical documentation required for workers- compensation benefit determination and substantiation of billed services. Obtain all necessary information for the completion of reports, including identification of the responsible Employer and Insurance Carrier and Claim Number. Review inpatient and outpatient medical records, automated systems to determine services rendered for work-related injury/illness and communicate information to carriers, billers and other interested parties.

Essential Functions:
  • Prepare Reports: Obtain all necessary patient, employer and carrier information needed to complete required Industrial medical reports: Doctor-s First Report of Occupational Injury or Illness, Form DLSR 5021 (-DFR-) and Primary Treating Physician-s Progress Report, Form PR-2 (-PR2-). Using daily exception report or other means, track receipt of reports from providers outside the Occupational Health Center. From physician-s notes, abstract information necessary to prepare industrial medical reports. Enter data into the Bedrock system. Identify appropriate diagnostic codes per the International Classification of Diseases (ICD-9). Obtain signature of Primary Treating Physician (PTP) or other provider as appropriate. Transmit required reports to appropriate insurance claims administrator in a timely manner per applicable state or federal law. Work to attain goals of completion of DFRs within the legally required 5 day timeline. Notify appropriate Business Office personnel upon discovery of billable services incorrectly registered as non-industrial. Prepare other related industrial injury forms as required by applicable state or federal law.
  • Research late discoveries and industrial injury: Investigate notification of previously unidentified industrial cases from insurance claims administrators, Business Office personnel, employers, patients and others. Review patient medical records for services related to the alleged industrial injury and generate required reports. Notify the appropriate Business Office personnel of industrial services not previously billed. Work cooperatively with Business Office personnel to obtain information needed to complete reports and release bills. Create -Claim Data Add- in Bedrock to support billing for industrial pharmacy charges not associated with existing claims (-Meds Only-)
  • Process Liens: Investigate notification of potential industrial cases based on applications filed with the WCAB. Review medical records to identify services related to the application. Notify the PBS Lien Hub of all services needing to be billed. Notify regional offices when no industrial services are identified. Create industrial medical reports necessary to support KP-s lien claim. Respond to carrier and Central Business Office correspondence and inquiries.
  • Process Denials/Awards/Returned Claims: Process notification of denial, WCAB Orders and Awards per applicable local or Regional procedures. Review incoming mail related to industrial cases and process per applicable local or Regional procedures.
  • Authorization/Communication: Answer incoming phone calls and process information from patients, physicians, employers, and insurance claims administrators. Respond to correspondence and inquiries from Central Business Office and insurance claims administrators. May contact insurance claims administrator to obtain payment authorization, subject to local clinic protocol.
  • 6. Other: Continue to pursue missing information such as OWCP claim numbers. Per local protocol, process and distribute incoming correspondence related to industrial medical reports. Perform other related duties as required including, but not limited to filing, answering the telephone, photocopying, assisting with orientation of other employees as requested, etc. Actively and consistently support the Labor Management Partnership. Comply with departmental, medical center and regional policies and procedures at all times. Actively participate in ongoing, employer-provided training to improve skill level. Perform other duties as assigned, not expected to exceed 5% of workload.

  • Basic Qualifications:
  • N/A
  • High School Diploma or equivalent years of experience
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Experience with automated systems/PC applications.
  • Requires certified course in Medical terminology or tested knowledge of medical terminology.
  • Basic Microsoft WORD and Excel skills, per testing.
  • Typing speed at 40 wpm. Good verbal/written communication skills.
  • Professional, courteous manner.
  • Commitment to customer service.
  • Must be able to work in a Labor/Management Partnership environment.

    Skills Testing*:Basic Microsoft Word, Excel, Typing 40 wpm, and Medical Terminology (able to pass standardized test)

    *If it is determined that you need to complete testing to qualify for this position, you will receive an email inviting you to take the assessment(s) listed above. Passing test scores remain on file for one year.

    Primary Location: California,Redwood City,Redwood City Veterans Medical Offices 1400 Veteran Scheduled Weekly Hours: 0 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 9:00 AM Working Hours End: 5:30 PM Job Schedule: Call-in/On-Call Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: United Healthcare Workers - West Job Level: Entry Level Job Category: Accounting, Finance and Actuarial Services 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.
  • About Accounting, Finance, & Actuarial Careers

    Accounting Careers

    Members of our accounting team support corporate projects and lend insight to areas such as financial reporting, tax planning and preparation, and audit management. This team also includes our audit professionals, who partner with financial and operational groups across the organization to analyze budgets and streamline procedures.

    Finance Careers

    Supporting critical business functions such as financial services, national Medicare finance, strategic planning, auditing, and corporate finance, our finance professionals develop the strategies that enable us to meet our financial goals.

    Actuarial Careers

    Applying probability and statistics to the practical problems of insurance, our actuarial team performs a variety of duties, including calculating the cost of premiums and policy values, preparing statistical studies, and forecasting financial results.

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