PearlandRecruiter Since 2001
the smart solution for Pearland jobs

Managed Care Claims Analyst

Company: Kelsey Seybold Clinic
Location: Pearland
Posted on: June 6, 2021

Job Description:

Overview

Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multispecialty clinic with over 25 locations and comprises more than 500 physicians providing primary and specialty care in a collaborative manner.

With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.

Kelsey-Seybold Clinic is changing the way health cares.

Responsibilities

Responsible for the adjudication of complex medical/dental claims while maintaining productivity and accuracy standards. Essential job functions include: application of various payment methodologies including but not limited to: case rates, RBRVS Fee Schedules, Usual and Customary rates as well as Contractual rate; including LOAs. Analyst must initiate internal documentation via Customer Relationship Module (CRM) to various departments within Managed Care as it pertains to Contracts, Eligibility, and Member Benefits. Perform departmental research necessary to effectively adjudicate claim payment. Essential job function includes the ability to interpret provider contracts and apply to claim payment. Working knowledge of system and/or payment guidelines and the ability to effectively apply those guidelines all while maintaining office standard on accuracy. Ability to work and function in an ever-changing environment with limited supervision.

Qualifications

Managed Care Claims Analyst

Location: Pearland Administrative Office

Department: ClaimsJob Type: Full Time

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

High School diploma or GED from an accredited program

B.

1 year of college experience

Experience

A.

5 years of claims adjudication experience in a HMO, PPO, or TPA environment or 6 months of Managed Care preprocessing experience.

B.

6 months experience Managed Care experience with KSC; and demonstrated ability to process complex medical claims.

Licenses

A.

N/A

B.

Special Skills

A.

Demonstrated understanding of medical terminology, CPT and ICD 9 and ICD 10 Codes, payment rates including RBRVS, Usual and Customary, L.O.A.s and Contractual agreements.Demonstrate strong working knowledge of industry standards regarding c.p.t.coding, coordination of benefits, hcpcs and Medicare reimbursement guidelines.Demonstrated knowledge of health plan benefits and financial obligation summary interpretation.Knowledge of primary payer's explanation of benefit; with ability to apply secondary paymentKnowledge and interpretation of letters of agreements and plan's financial obligation summary.Able to interpret and apply contractual rates to claims adjudications, fee schedules and reimbursement methods.

B.

Epic - Tapestry Module

Other

A.

Self directed and able to absorb new material quickly

B.

WORKING ENVIRONMENT

Office

Keywords: Kelsey Seybold Clinic, Pearland , Managed Care Claims Analyst, Other , Pearland, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Pearland RSS job feeds