Job Summary In accordance with State and Federal workers' compensation laws and regulations, creates and maintains medical claim information and industrial medical reports using internal applications and systems. Determines correct employer, insurance carrier and claim number for assignment to claim file and reports. Obtain all necessary information for the completion of reports. Ensures correct assignment of industrial visits for billing and reporting. Investigates potential reportable industrial treatment and prepares claim files and reports accordingly. Communicate with employers, insurance carriers and other permissible parties. Ensure follow up treatment is scheduled in accordance with the treatment plan. Essential Responsibilities Create and Maintain Reports: For all medical services related to treatment of industrial injuries or illnesses: Create and maintain complete industrial claim files using internal systems. Obtain, validate and update all necessary patient, employer and carrier information needed to create, complete and/or maintain industrial medical reports as required by law using internal applications or systems. Using daily registration reports, internal systems or other means, track necessity of industrial documentation and create reports linked to industrial claim file. From physician's notes, abstract information necessary to prepare industrial medical reports. Enter data into the internal applications and systems. Ensure appropriate diagnostic codes. Obtain necessary signatures from providers as appropriate. Preform quality assurance control by linking registrations and documentation to correct industrial claims file. Ensure follow up treatment is scheduled in accordance with the treatment plan. Transmit required information, reports and forms to appropriate insurance claims administrator in a timely manner and within program service standards and/or applicable state or federal law. Prepare other related industrial injury forms as required by applicable state or federal law. Late Discoveries and Out of Occ: Investigate and validate late discoveries and services rendered outside of the Occupational Health Department. Create reports and claim files for late discovery cases using internal systems and applications. Notify Revenue Cycle upon discovery of billable services incorrectly registered as non-industrial. Investigate notifications of previously unidentified industrial cases from insurance claims administrators, Revenue Cycle, employers, patients and others. Review patient medical records for services related to the alleged industrial injury and generate required reports. Work cooperatively with Revenue Cycle to obtain information needed to complete reports and release bills. Document and create claim using internal applications and systems to support billing for industrial pharmacy charges not associated with existing claims ('Meds Only). Process Claims: Process and document incoming and outgoing correspondence related to the claim. Review, document and process incoming mail/correspondence and inquiries related to industrial cases. Notify Revenue Cycle and other necessary personnel of denied and unauthorized claims. Process and document administrative closures. Contact employers, claims administrators and others to obtain treatment authorization and to identify responsible third-party payer, for Workers Compensation visits. Communication: Manage incoming and outgoing phone calls, document and process information from patients, physicians, employers, insurance carriers and other permissible parties. Other: Support efforts to maintain Regional Service Standards with respect to report timeliness, quality, work status communication, customer inquiries, etc . Actively participates in training new personnel. Actively participates in employer provided training. Perform other related duties as assigned. Minimum Qualifications Minimum Education · High School Diploma or General Education Diploma (GED) required. Basic Qualifications · Minimum (2) two years' experience in Occupational Health OR Workers Compensation, OR Insurance experience in the field of claims processing, adjudication, and claims examiner. Additional Requirements · Must pass medical terminology, Microsoft Word, and Microsoft Excel per testing. · Experience with electronic medical records/PC applications. Good verbal/written communication skills. · Must be customer oriented · Must be able to work in a Labor/Management Partnership environment. · Must be able to pass 40 wpm typing test. Preferred Qualifications · Knowledge of California workers' compensation law or claims process. · Familiarity with ICD diagnosis coding system. DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by incumbents assigned to this job. This is not intended to be an exhaustive list of all the responsibilities, duties and skills required. The incumbent may be expected to perform other duties as assigned. 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. COMPLIANCE & INTEGRITY: 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 (if applicable), and Kaiser Permanente's policies and procedures. Models and reinforces ethical behavior in self and others in accordance to 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. All Directors, Managers and Supervisors are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments. SERVICE & QUALITY: 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. WORKPLACE SAFETY: In addition to defined working conditions and physical requirements, employees are accountable for working safely; following established policies & procedures; utilizing all designated protective personal equipment (PPE) and/or safety equipment assigned for task; and reporting all injuries and hazards to their supervisor immediately. Supervisors and Managers are accountable for ensuring the safety performance of employees; applying consistent practices in compliance with federal, state and local regulations; providing guidance to maintain a safe and healthy work environment. COMPANY: KAISER TITLE: Industrial Report Billing LOCATION: Fremont, California REQNUMBER: 1328950 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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.