Position will primarily support all Managed Care Quality Improvement initiatives. Primary responsibilities include:
QI performance of unit/system processes including: HPE Audit, Background Adjudicator, Claim Service (Adjustment review/list), Provider
Service CRM Topic, Create provider specific reports, perform high dollar claims analysis and monthly purchase service analysis.
Responsibilities include review/assess work flow processes including polices & procedures for each unit. Audit performance of applicable
tasks. Identify Performance gaps. Additional responsibilities include: Claims testing support for system upgrades and implementations.
Identify discrepancies (i.e. overpayments/underpayments, contract build, benefit build). Assist with QI documentation. Assist with training
documentation relative to EPIC Tapestry services (Claims Adjudication, CRM-Customer-Relationship Module for Claims, Provider Services,
Coordination of Benefits, Appeals and Claim Services.) Assist with training/ orientation of both facility and professional claims adjudication.
Assist with training and development as needed.
Job Title: Claims Quality Assurance Analyst
Clinic Location: Pearland Administration Office Building
Job Type: Full Time
Salary Range: $48,755.00 – $30,237.00 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: Associates Degree or Diploma with equivalent industry experience
5 years of claims adjudication experience or 2 years of Claims Q/A or supervisory experience. Knowledge of Managed Care Product including Contract knowledge.
Familiarity with reimbursement methodologies, CPT codes and ICD-9. HCPCS, DRG, Revenue Codes. Demonstrate public speaking and presentation skills. Proficient use of Microsoft products including excel, word, power point. Excellent written and oral communication skills
Preferred: Report development experience (citrix, crystal, etc.)
Required: Word processing experience, must be Excel, Access and Power Point
Required: Strong orientation to customer satisfaction processes. Self motivated. Able to work independently of direct supervision.
Working Environment: Office
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