OHS Claims Processor II

Description : 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.
30+ days ago