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OHS Claims Processor I

Primary Location Riverside, California Worker Location Onsite Job Number 1334856 Date posted 03/12/2025
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Description:
Job Summary:

Under direct supervision, provides patient/visitor receptionist; check in and out; cash handling appointment scheduling; and other Occupational Health Services department at clerical duties as directed.  Obtains employer/carrier information for billing/reporting purposes; contact employer/carriers to obtain authorization for treatment or report status of claim.  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 account 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 administrator/carriers and employer/clients.  Must be able to provide status of claim; creates patient accounts and files; Input and maintain information on all appropriate systems as utilized by Kaiser Permanente.  Requires excellent interpersonal skills and ability to multitask in busy environment.

Essential Responsibilities:


  • Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.

  • Answer and screen incoming phone calls or department.  Receives and filter messages to provider/clinicians/case managers/case coordinators through the Health Connect system and reply as appropriate.  Greet patients/visitors and determine nature of visit. Handles customer inquiries.  Assist patients in completing forms.  Request for internal/external records.  Create accounts in the KP internal systems.  Transfer charges to the appropriate KP Health Connect patient account.  Contact employer/carrier for authorization/notification of treatment; request medical chart for the OHS physician appointments or if necessary in order to compile accurate information for reporting purposes.

  • Schedule appointment for workers comp patients at Fontana/Riverside Medical Centers and participating outlying clinics; Interact with internal departments as well as outside carriers/employers to schedule appointments or obtain information for completion of forms.  Make rounds to certain internal department to retrieve paperwork as necessary.

  • Consolidate or corrects duplicate accounts by using appropriate system functions.  Enter account notes on patient cases.  Review subpoena request.  Review KP internal systems to ensure that duplicate visits are not captured.  Complete transfer of care form.  Clear designated Health Connect work queues daily.

  • Handle physician master scheduling for OHS.

  • Open and distribute mail to proper areas, match bills to reports and mail to carrier along with any other documentation as necessary.

  • Create and prepare file for further processing/billing purposes; filing as required.

  • Type various documents as required in our current KP systems.

  • Payment and collection for OHSS services as required.

  • Create patient accounts; add/update notes in on-line computer system as applicable; coordinate file with proper bills/reports.

  • Prepare office supply orders.

  • Performs other duties as required.

  • Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes 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 licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.  


    • In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
    Basic Qualifications:

    Experience


    • Minimum of one (1) year relevant clerical and customer service experience in Workers Compensation.


    Education


    • High School Diploma or equivalent.


    License, Certification, Registration


    • N/A


    Additional Requirements:


    • Typing 35 wpm required. All testing must be completed by the end of posting period.

    • Successfully passed a medical terminology test.

    • Knowledge of Workers Compensation Claim 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 Equipment

    • Typewriter


    Preferred Qualifications:


    • N/A



    Notes:


    Employee can be asked to float from Riverside to Wildomar Trail or Moreno Valley-Heacock.


    Schedule to include rotating weekends, holidays and floating within the established seniority sections.


Primary Location: California,Riverside,Riverside Administration Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 08:30 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Onsite Employee Status: Regular Employee Group/Union Affiliation: B05|USW|Local 7600 Job Level: Individual Contributor Department: Riverside Med Center - Occupational Health-Reg Clin - 0806 Pay Range: $25.58 - $28.22 / 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, 25 % of the Time On-site: Work location is on-site (KP designated office, medical office building or hospital). 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.

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.
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