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.
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.
Managed Care Claims Analyst
Location: Pearland Administrative Office
Department: ClaimsJob Type: Full Time
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
High School diploma or GED from an accredited program
1 year of college experience
5 years of claims adjudication experience in a HMO, PPO, or TPA
environment or 6 months of Managed Care preprocessing
6 months experience Managed Care experience with KSC; and
demonstrated ability to process complex medical claims.
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
Epic - Tapestry Module
Self directed and able to absorb new material quickly