Claims Processing Specialist
Location: Pearland Administrative Office
Job Type: Full Time
Department: Business Office
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 21 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.
Under the supervision of the Business Services Supervisor, the Claim Edit Follow-Up Representative is responsible for processing the electronic claims edits, “ front end “ edits, as well as claims edits from secondary claims. In the event a claim edit does not pass, the Follow-Up Representative must determine the required action and steps necessary to resolve the claim issue. The Claim Edit Follow-Up Representative will be expected to review and resolve a No-Activity Workfile/Workqueue, which consist of accounts that have no payment or rejection posted on the account and follow Kelsey-Seybold Clinic Central Business Office policies and procedures to determine the appropriate action.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
A. High School diploma or GED
B. Additional training as a medical office assistant, medical claims processor, or medical claims follow up specialist.
A. Minimum of 3 years billing experience, knowledge of healthcare business office functions and their relationships to each other. (i.e. billing, collections, customer service, payment posting) and insurance products such as managed care, government and commercial products.
B. Three or more years experience in a healthcare business office setting, preferably in electronic claims billing, or insurance follow up.
A. Must be familiar with laws and regulations governing Medicare billing practices, medical billing systems, and claims processing.
B. IDX/EPIC, PC skills, and understanding of billing invoice activity such as credits, debits, adjustments, contractual agreements, etc.