Provider Service Representative I
Location: Pearland Administrative Office
Job Type: Full-Time
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.
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)
A. High School Diploma
B. Some College
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
A. Alpha/numeric data entry
B. Strong knowledge of HMO, PPO and POS plan types a plus
benefit interpretation a plus
A. Excellent verbal communication skills and ability to speak english language fluently
B. Spanish speaker