Kelsey-Seybold

Provider Services Representative I

US-TX-Pearland
1 week ago
Job ID
2017-18418
Category
Clerical/Administrative Support

Overview

Provider Service Representative I

Location: Pearland Administrative Office

Department: Claims

Job Type: Full-Time

 

COMPANY PROFILE

Kelsey-Seybold Clinic. Your Doctors for Life.

Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.​​

 

JOB SUMMARY

Responsible for handling all inquires from KelseyCare members regarding eligibility, prescription drug issues, interpretation and communication of covered benefits and exclusions, referral inquires, clinic information and coordination of claims status for claims processed at Kelsey-Seybold Clinic and TPA.

Responsible for calls from members and providers regarding referral inquires.

Responsible for handling all inquires from members and affiliate providers regarding claim status. Assist providers with appeal process.

 

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

 (A = basics; B = preferred)

 

EDUCATION      

A. High School Diploma

B. Some College

 

EXPERIENCE    

A. 2 years customer serrvice/medical experience and medical terminology

B. Significant KS related experience (patient account analyst, business office, & PSR)

     Previous member service experience with a medical group or health plan

     Previous experience with call tracking system

 

LICENSES

N/A

 

SPECIAL SKILLS              

A. Alpha/numeric data entry

B. Strong knowledge of HMO, PPO and POS plan types a plus

      benefit interpretation a plus

 

OTHER 

A. Excellent verbal communication skills and ability to speak english language fluently

B. Spanish speaker

 

WORKING ENVIRONMENT

Office

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed