Data Intake Specialist - Kelsey-Seybold Clinic - KelseyCare Advantage Admin - 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. The Data Intake Specialist is responsible for accurately entering, reviewing, and validating data in departmental processing systems, maintaining a 99%25 accuracy standard. Primary Responsibilities: This role processes mail, including faxes, emails, written correspondence, and calls from Member Services, while requesting and adding necessary documents from members and providers. The Specialist also provides critical support to the Appeals & Grievances, Billing, Coordination of Benefits, and Enrollment teams by ensuring accurate data entry and seamless communication across these functions This position supports the provider dispute process by performing front-end data entry and administrative tasks, including entering disputes into the Epic system, conducting initial case assessments, and creating necessary documentation in the CRM system. The Specialist also reviews and analyzes departmental reports, escalating issues and trends to management as needed In addition, the Specialist identifies and implements workflow improvements, provides technical insights, and recommends future department strategies and system enhancements. They collaborate with internal and external departments, including Appeals & Grievances, Billing, Coordination of Benefits, and Enrollment teams, to optimize workflows and support system upgrades through testing and feedback 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 equivalent
- 1+ years of healthcare industry or 3+ years customer service experience or 1+ years of quality assurance experience
- 3+ years of experience with various applications to include: Excel, Word, and Microsoft Edge
Nice To Haves
- 1+ years of experience in Claims
- 3+ years of experience ASO Products / Managed Care
- Experience with Medicare Guidelines
- Experience with EPIC CRM
- Experience CMS MARx system
Responsibilities
- processes mail, including faxes, emails, written correspondence, and calls from Member Services, while requesting and adding necessary documents from members and providers
- provides critical support to the Appeals & Grievances, Billing, Coordination of Benefits, and Enrollment teams by ensuring accurate data entry and seamless communication across these functions
- supports the provider dispute process by performing front-end data entry and administrative tasks, including entering disputes into the Epic system, conducting initial case assessments, and creating necessary documentation in the CRM system
- reviews and analyzes departmental reports, escalating issues and trends to management as needed
- identifies and implements workflow improvements, provides technical insights, and recommends future department strategies and system enhancements
- collaborates with internal and external departments, including Appeals & Grievances, Billing, Coordination of Benefits, and Enrollment teams, to optimize workflows and support system upgrades through testing and feedback
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
Education Level
High school or GED
