Occupational Health Service Clerk

Job Summary:

Under indirect supervision, assists in maintaining patient/employer relationships as it relates to Industrial/Occupation, Workers Compensation and No-Fault inquiries; compiles and reports department statistics; assists in communicating and monitoring of processing insurance claims, reports and billing of patients and members being compensated for medical disability benefits; coordinates and processes m.d. monthly schedules; schedules and registers Industrial and No-Fault patients, Occupational Health Services, PEs and Drug Screen patients and provides patient attending services as required; performs clerical functions as needed.

Essential Responsibilities:

• Assists in obtaining and providing to patient or employer by telephone or personal contact any Industrial/Occupational medical information, advice or explanation of problems pertaining to benefits, applications, status, eligibility, form filing and time limits; refers difficult or involved problems to supervisor or other appropriate individual within Industrial/Occupational organization.
• Assists with communication and correspondence of functional Industrial data and information with variety of Kaiser personnel in other departments, such as Diagnostic Imaging, outlying clinics, Industrial Insurance, and Risk Management by telephone, written material or in person to ensure proper handling and completion of claim requests.
• Assists and participates in new patient/employee orientation; verifies patient benefits per Kaiser Health Plan; interprets rules and regulations of Health Plan, Workers Compensation, and No-Fault as it applies to each specific case.
• Receives, reviews, and triages request for medical information, visit records, insurance billing forms, and other pertinent documents for completeness and accuracy to ensure efficiency in processing of claims; creates requests and maintains Industrial/Occupational Clinic documentation for encounter cases; creates/obtains unit medical charts, industrial medical charts and all other data pertaining to request.
• Assists facilitation of referral process; coordinates prior approvals from insurance carriers; tracks follow-up approval requests; coordinates appointments within and outside Kaiser; ensures completion and receipt of appropriate documentation required; completes data entry requirements.
• Maintains current Industrial Occupational Medicine departmental files; operates usual office machines such as telephone, ES900 and SIM computer, calculator, 10-key, CRT, duplicator, typewriter, and fax.
• Receives telephone calls and correspondence; handles inquiries and complaints pertaining to patient care issues; refers to team leader or Supervisor as needed.
• Inputs and updates SIM on all OHS, Workers Compensation, No-Fault, pre and post encounter patient information on daily basis.
• Prepares monthly physicians calendar/appointment schedule; coordinates physician activities (e.g., meetings and depositions as needed making necessary adjustments to monthly calendar/appointment schedule).
• Assists with communication and correspondence with insurance carriers, employers, doctors, patients, attorneys and others to obtain and exchange complete and valid information regarding patient workers compensations injury claim to ensure proper handling and completion of claims/request.
• Answers follow up inquiries from third party payers, and/or patients; documents same in patients medical and industrial charts.
• Audits pertinent data from patients medical records, visit records, nurses/doctors note and various fee schedules/documents to process insurance claims and reports complying with State and Federal regulation, laws, guidelines and Kaiser Health Plan policies; prepares billing and invoices referring to fee schedule.
• Maintains familiarity with State, Federal, City and County and community agencies to assure proper and adequate exchange of data and information to ensure proper handling and completion of claims/request.
• Handles inquiries and complaints pertaining to patient visit; provides ongoing assistance and information to claimant, insurance carrier, attorneys and providers while simultaneously ensure patient confidentiality with current Federal/State laws and Kaiser Permanente Corporate policy.
• Contacts various departments to reconcile discrepancies; maintains control logs to insure correct computer processing of data; researches and analyzes errors and modifies same.
• Provides accurate data and prepares for daily, weekly and monthly revenue statistics for Industrial Occupational Medicine Department.
• Gathers, reviews, and corrects source documents and reports from Industrial-Occupational Medicine Department relating to utilization data; coordinates and maintains Industrial visit encounter forms, Industrial Insurance forms, physician/nurses reports and data for internal tracking system of current status.
• Registers on appropriate documents each Industrial and No-Fault patient requesting medical service, workslip, refill and supplies; obtains routine personal medical information from patient.
• Requests triage by Industrial RN when necessary; witnesses signed consents by patient.
• Prepares and enters patient information into SIM system including EDS and case management.
• Assists and creates standardizing of SIM computer system forms, format, and data collection.
• Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.
• Performs other duties and accepts responsibility as assigned.