Outpatient Referral Clerk

Kaiser Permanente; Los Angeles (CA); On-site; USD 28,000 - 36,000; Part time

Job summary

Kaiser Permanente seeks a detail-oriented clerk to manage outside referrals, verify authorization for services, and monitor related expenditures. The role involves data entry, report generation, and handling invoices within a health care setting.

Requirements include basic medical terminology, 40 wpm typing, and ICD-9/CPT coding certification or equivalent experience. This on-call position requires effective interpersonal skills and the ability to work with diverse teams.

Qualifications

• Requires knowledge of medical terminology and billing processes.
• Typing speed of 40 words per minute with current score within the last year.
• Demonstrates interpersonal skills and teamwork in a diverse environment.
• ICD-9 and CPT coding certification or equivalent experience is preferred.

Responsibilities

• Maintain records of physician outside referrals and verify authorization.
• Monitor expenditures and ensure payment appropriateness.
• Enter data into automated systems and print computer reports.
• Answer member inquiries and route calls; organize department files.
• Review invoices and payment documents for approval authority; handle rejections.

Skills

Medical Terminology

Typing 40 wpm

Effective interpersonal skills

Ability to work with diverse groups

Education

ICD-9 and CPT coding certificate or equivalent experience

Job description

Under supervision, maintains current records of all physician outside referrals; verifies that outside referrals have proper authorization for prescribed services; monitors expenditures to determine appropriateness of payment per establishes guidelines and sets up reporting systems for the processing of forms required for outside referrals and the payment of outside services rendered.

Essential Responsibilities:

This description is for recruitment posting purposes only. It has not received full HR review and approval.

• Patient/Member Care.
• Answer member inquiries.
• Information and Records.
• Enter data into automated systems.
• Print and distribute computer reports.
• Answer and route telephone calls.
• Organize and maintain department files, records, handbooks and manuals.
• Remove deactivated files for storage.
• Finance/Accounting.
• Review incoming invoices and payment request documents for approval authority.
• Return unauthorized documents.
• Sort bills by type and forward to appropriate department.
• Maintain records of outside referrals.
• Verify outside referrals have proper authorization for prescribed services.
• Monitor expenditures to determine appropriateness of payment.
• Review bills for outside referral services and verifies charges.
• Contacts outside physicians/hospitals when changes do not correspond to authorized services.
• Maintain statistical reports on outside referral activity and charges.
• Materials and Supplies.
• Operate copier equipment.
• Other Activities and Responsibilities.
• Assume other activities and responsibilities from time to time as directed.

Basic Qualifications:

Experience

• Medical Terminology or one (1) year experience in Medical Field.
• Typing 40 wpm.
• Typing score must be current within one (1) year.
• Please contact Human Resources for testing.
• Effective interpersonal skills.
• Able to work with diverse groups of individuals.
• Consistently demonstrates the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to each other, to our members and to customers, contracted providers and vendors.
• ICD-9 and CPT coding certificate or equivalent experience.
• Effective interpersonal skills.
• Able to work with diverse groups of individuals.
• Consistently demonstrates the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to each other, to our members and to customers, contracted providers and vendors.

Education

• N/A

License, Certification, Registration

• N/A

Preferred Qualifications

• N/A

Notes:

• This is an on call position, days and hours may vary.