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.

    • • 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.

    • • 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.

    PrimaryLocation : California,Bakersfield,Stockdale Medical Offices
    HoursPerWeek : 30
    Shift : Day
    Workdays : Mon, Tue, Wed, Thu, Fri
    WorkingHoursStart : 11:00 AM
    WorkingHoursEnd : 05:00 PM
    Job Schedule : Part-time
    Job Type : Standard
    Employee Status : Regular
    Employee Group/Union Affiliation : B20|UFCW|Local 770
    Job Level : Individual Contributor
    Job Category : Insurance
    Department : Stockdale MOB – Occupational Health-Reg Clin – 0806
    Travel : No
    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.