Responsible for the adjudication of complex medical/dental claims while maintaining productivity and accuracy standards. Essential job
functions include: application of various payment methodologies including but not limited to: case rates, RBRVS Fee Schedules, Usual and
Customary rates as well as Contractual rate; including LOAs. Analyst must initiate internal documentation via Customer Relationship
Module (CRM) to various departments within Managed Care as it pertains to Contracts, Eligibility, and Member Benefits. Perform
departmental research necessary to effectively adjudicate claim payment. Essential job function includes the ability to interpret provider
contracts and apply to claim payment. Working knowledge of system and/or payment guidelines and the ability to effectively apply those
guidelines all while maintaining office standard on accuracy. Ability to work and function in an ever-changing environment with limited
Job Title: Managed Care Claims Analyst
Clinic Location: Pearland Administration Office Building
Job Type: Full Time
Salary Range: $41,059.00X – $50,710.00 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: High School diploma or GED from an accredited program
Preferred: 1 year of college experience
Required: 5 years of claims adjudication experience in a HMO, PPO, or TPA environment or 6 months of Managed Care preprocessing experience.
Preferred: 6 months experience Managed Care experience with KSC; and demonstrated ability to process complex medical claims.
Required: Demonstrated understanding of medical terminology, CPT and ICD 9 and ICD 10 Codes, payment rates including RBRVS, Usual and Customary, L.O.A.s and Contractual agreements. Demonstrate strong working knowledge of industry standards regarding c.p.t. coding, coordination of benefits, hcpcs and Medicare
reimbursement guidelines. Demonstrated knowledge of health plan benefits and financial obligation summary interpretation. Knowledge of primary payer’s explanation of benefit; with ability to apply secondary payment Knowledge and interpretation of letters of agreements and plan’s financial obligation summary. Able to interpret and apply contractual rates to claims adjudications, fee schedules and reimbursement methods.
Preferred: Epic – Tapestry Module
Required: Self directed and able to absorb new material quickly
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