Job Summary: Under general supervision and in accordance with established policies and procedures, abstracts and complies pertinent medical information form the patients medical record in response to requests and subpoena inquires received. Provides services related to outpatient registration and outside medial authorization processing.
Essential Responsibilities: - Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws. 1. Reviews request received from outside providers, agencies, schools and attorneys. Verifies that proper authorizations are obtained in compliance with all regulations, requirements, laws and guidelines as promulgated by licensing, accrediting, or regulatory bodies. Orders Medical records, obtains missing authorizations and verifies that appropriate information is in the records. 2. Answers and screens incoming phone calls for department. A screen inquires related to various services and medical centers general health related questions. 3. Assists patients or requestor by telephone or in person in obtaining release of medial information by obtaining required release authorization, determining urgency of request, screening to determine needs and initiates procedures to facilitate request. 4. Abstracts patients chart to obtain requested medical information; summaries and composes information for outside medical facilities, physicians, government agencies and schools. Composes and types letters or forms to provide information requested. 5. Prepares narrative style medical reports for a variety of claims by abstracting and paraphrasing hospital and clinic chart entries, reviews and discusses complex or unusual medial cases directly with the treating or supervising physician, and writes non-routine letters on an individual basis. 6. Communicates by telephone and letter directly with employers, union and insurance company representatives, attorney and other professional people for authorization and other information required to process the members various health related forms. 7. Reviews patients records and requests physicians to dictate complicated cases; maintains liaison between physician and requestor. 8. Transcribes physicians patient-related correspondence from central dictation system or handwritten letters. 9. Completes required forms and letters using computer software of typewriter. 10. Initiates requests for medical histories by typing designated medical request forms, mailing to appropriate agency or physician, and following-up when request is not answered within designated time.
- 11. Monitors outside medical continuing care cases and secures proper authorization for payment. Assures authorizations adhere to contractual guidelines for proper processing. 12. Codes various health related forms for completion as required using ICD-9/ CPT codes or other approved coding system. 13. Bills, collects and reconciles any applicable fees for providing requested information. Makes adjustments as required on disputed billing inquires. 14. Verifies receipts with payments received, prepares bank deposit, posts transactions to accounts, balancing account entries to bank deposit. Requires working knowledge of current accounting data base system. 15. Assists medical center personnel by providing written material, training and answering technical questions pertaining to proper completion of established security and cash control procedures, computer program updates and Health Plan benefit changes. 16. Accepts subpoenas and authorizations for various attorneys and agencies. Coordinates the copy of these medial records with outside providers. Assures only authorized records are released. 17. Greets Health Plan members, discusses, counsels and instructs patients on how to handles requested medical information, coordinates processing of forms and letters. 18. Maintains allergy antigen accounts, confirms health plan status and antigen materials are current. 19. Maintains computer tracking system of health related requests. Maintains departments records, filing systems, prepares follow-up forms and photocopies records as necessary. 20. Opens, sorts and distributes mail. Orders department supplies as needed and assures supplies are maintained and charges correctly. 21. Specific duties may vary according to desk assignment. 22. Helps familiarize staff in essentials of position. 23. Performs other duties as required. 24. Promotes, ensures, and improves customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service. 25. Works designed HealthConnect work queues as assigned Assume other activities and responsibilities from time to time as directed.