Tapestry SME Research Analyst Kelsey Seybold Clinic

Kelsey-Seybold Clinic•Brookside Vl, TX

4d•$20 - $36

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.

Requirements

High School diploma or GED from an accredited program with equivalent industry experience
5+ years of claims adjudication experience or 2+ years of Claims Q/A or supervisory experience
Proven knowledge of Managed Care Product including contract knowledge
Demonstrated familiarity with reimbursement methodologies, CPT codes and ICD-9, ICD-10. HCPCS, DRG, Revenue Codes
Proficient use of Microsoft products including Excel, Word, Power Point
Proven solid understanding of the Accountable Care model
Demonstrable knowledge of clinical data sets (CPT, HCPCS, ICD-9, ICD-10, etc.)
Proficiency with Microsoft Word, Excel, and familiar with Access and Power Point
Valid Texas Driver’s License

Nice To Haves

Demonstrated public speaking and presentation skills
Proven excellent written and oral communication skills
Reporting experience

Responsibilities

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
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