Kelsey-Seybold Clinic
Responsibilities
Under the supervision of the Business Services Supervisor, the Claims Processing Specialist will drive speed to payment and improved revenue yield in a fast-paced environment by ensuring all claims are submitted to the payor timely and accurately. Tasks include resolution of all assigned claim edits. In the event a claim edit does not pass, the Representative must determine the root cause of the claim submission exception and take the necessary actions, including but not limited to insurance verification, to resolve the claim issue. The Claim Submission & Follow-Up Representative determines claims status of no reject/no response claims and follows Kelsey-Seybold Clinic Central Business Office policies and procedures to take appropriate follow-up action to affect resolution of the claim. The Representative is
required to meet work productivity standards and performance measures for this position. Professionalism and courtesy are expected when communicating with external contacts to resolve claims issues and patients to explain financial liability, advise of non-coverage, process payments and payment plans, and clarify Explanation of Benefits and statement of physician services. Exhibits exceptional customer skills to provide the patient with a positive service experience.
Job Title: Claims Processing Specialist
Clinic Location: Pearland Administration Office Building
Department: Business Office Prior Authorization and Claims
Job Type: Full Time
Salary Range: $37,669 – $46,530 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications
Education
Required: High School diploma or GED from an accredited program
Preferred: Associates degree in Business Administration or related field; or successful completion of Coding and Billing Certificate Program.
Experience
Required: Requires 3 or more years current experience in a health care billing and collection environment or relevant health care setting using an accounting/health care computer system; or one year of related experience with preferred education.
Preferred: 5 years’ experience in a healthcare business office setting, preferably in electronic claims billing or insurance follow up. Epic Professional
Billing experience a definite plus as is an understanding of a diversity of insurance plans.
License(s)
Required: N/A
Preferred: N/A
Special Skills
Required: Basic PC and Internet literacy. Must be familiar with laws and regulations governing Medicare billing practices, medical billing systems, and claims processing. Good problem-solving skills. Ability to handle a variety of tasks with speed, attention to detail and accuracy.
Preferred: Understanding of billing invoice activity such as credits, debits, adjustments, contractual agreements, etc.
Other
Required: Excellent interpersonal communications skills and ability to communicate effectively both orally and in writing with patients, physicians,
management, and third-party representatives.
Preferred: N/A
Working Environment: Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance