Claims Recovery Analyst - Business Office - Kelsey Seybold - Pearland
About The Position
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. This position requires research of all Claims when suspended for dual coverage, pre-existing research, and coordination of benefits investigation. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- High School diploma or GED from an accredited program
- 2+ years of Managed Care Experience in Claims Administration with KSC as Claims Analyst or Provider Service Representative or 3 years of Claims Payment, Claims Billing, or Coordination of Benefits Experience in another Healthcare environment
- Understanding and interpretation of Managed Care claims payment process including electronic claims adjudication, contractual agreements, Financial Obligation Summaries, L.O.A.' s, Medicare/HCFA guidelines, Coordination of Benefit rules, State mandated processes specific to recovery and claims payment requirements. (Senate Bill 418)
Nice To Haves
- 1+ years of Claims Collections or Recovery experience
- Knowledge of Direct Provider Network Product
- Self-directed and able to absorb new information quickly. Knowledge of ICD-9, CPT Codes
Responsibilities
- Analyst will apply coordination of benefits procedures to claims with confirmed dual coverage via use of the Epic Systems
- Add/modify filing order information in EPIC System as well as documenting COB information in the system. Refund posting via EPIC system
- Prepare monthly summary and forward payments received to accounting department
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Insurance Carriers and Related Activities
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
