Responsibilities

　　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 supervision.

　　Job Title: Managed Care Claims Analyst - KS Plan Advantage-Claims

　　Clinic Location: Pearland Administrative Office

　　Department: KS Plan Advantage-Claims

　　Job Type: Full Time

　　Salary Range: $41,880 - $51,725 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

　　Qualifications

　　Education

　　Required: High School Diploma or equivalent

　　Preferred: 1 year of college experience

　　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.

　　License(s)

　　Required: N/A

　　Preferred: N/A

　　Special Skills

　　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

　　Other

　　Required: Self directed and able to absorb new material quickly

　　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

　　Kelsey-Seybold Clinic strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by organizational policy or by federal, state, or local laws unless such distinction is required by law. Kelsey-Seybold is a VEVRAA Federal Contractor and desires priority referrals of protected veterans.