Kelsey-Seybold Clinic

Receive alerts when this company posts new jobs.

Similar Jobs

Job Details

Senior Claims Analyst

at Kelsey-Seybold Clinic

Posted: 2/6/2020
Job Reference #: 20832

Job Description

  • LocationUS-TX-Pearland
    Posted Date3 days ago(2/17/2020 6:26 PM)
    Job ID
    2019-20832
    Category
    Professional/Managerial
  • Overview

    Sr. Claims Analyst

    Location: Pearland Administrative Office

    Department: Claims
    Job Type: Full Time


    COMPANY PROFILE

    Kelsey-Seybold Clinic. Changing the way health cares.

    Kelsey-Seybold Clinic is Houston’s premier multi-specialty group practice, founded in 1949 by Dr. Mavis Kelsey. With 19 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.

    JOB SUMMARY

    Conduct departmental training and one on one end user development sessions. Support claims testing, troubleshooting and research relative to vendor, provider & benefit build, including referrals associated with the overall claims adjudication process. Subject Matter Expert in facility and professional claims adjudication. Will support claims testing relative to system build including vendor/provider contracts and benefit build, upgrades, implementation, software and Epic Systems (Tapestry) usage. Create test scenarios to support administrative workflows, data collection, error analysis and corrections and provide written summary of research/findings to Claims Department Leadership. Support all auditing/quality performance initiatives. Maintain in depth knowledge of Epic Tapestry Systems and software, serve as liaison, identifying both user and system issues during testing and research. Perform adjudication of facility and professional claims as assigned. Resolution of assigned claim projects. Other duties as assigned.

    EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

    (A = basics; B = preferred)

    Education

    A.

    Associates Degree or High School diploma or GED from an
    accredited program with equivalent industry experience

    B.

    Experience

    A.

    • 5 years of claims adjudication experience or 2 years of
    Claims Q/A or supervisory experience
    • Knowledge of Managed Care Product including Contract
    knowledge.
    • Familiarity with reimbursement methodologies, CPT codes
    and ICD-9, ICD-10. HCPCS, DRG, Revenue Codes
    • Demonstrate public speaking and presentation skills.
    • Proficient use of Microsoft products including excel, word,
    power point
    • Excellent written and oral communication skills

    B.

    Reporting Experience.

    Licenses


    Skills

    A.


    A.

    Valid Texas Driver’s License


    Excellent customer service and telephone etiquette skills

    B.


    B.


    Special Skills

    A.

    Critical thinking skills.

    B.

    Other

    A.

    Ability to speak, write and understand the English language

    B.

    WORKING ENVIRONMENT

    Office