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Senior Claims Analyst
at Kelsey-Seybold Clinic
- Job ID
Sr. Claims Analyst
Location: Pearland Administrative Office
Job Type: Full Time
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.
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)
|Associates Degree or High School diploma or GED from an|
accredited program with equivalent industry experience
• 5 years of claims adjudication experience or 2 years of
Valid Texas Driver’s License
Excellent customer service and telephone etiquette skills
Critical thinking skills.
Ability to speak, write and understand the English language