Kelsey-Seybold

  • Claims Verification Operator

    Location US-TX-Pearland
    Posted Date 3 weeks ago(4/4/2018 12:55 PM)
    Job ID
    2018-18825
    Category
    Clerical/Administrative Support
  • Overview

    Claims Verification Operator

    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

    The Scan Operator is tasked with Claims Preparation and Batching of claim forms and correspondence within EPIC (Tapestry). The Scan Operator will utilize DataCap software to perform scanning and verification procedures of claim forms (UB04, CMS 1500 and Correspondence) which includes batch verification, document integrity review, page type, document form type verification, attachment review and confirmation functions.  The Scan Operator will also  perform data and image comparisons relative to Claim Data (billed amount, units, dates, CPT Codes, Diagnosis Codes, additional Insurance Information, member demographic Information, Provider/Vendor selection and Benefit information. The Operator will complete Data correction tasks for discrepancies, create discrepancy log, create inventory log of claims received by individual healthplans.  Additional tasks include claim (logging) number assignment of (paper claims) into Tapestry. (Vendor Set-Up/Benefit Inquiry) rules will apply.

     

    EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

    (A = basics; B = preferred)

     

    Education

    A.

    High School Diploma or GED

    B.

     

    Experience

    A.

    2 years of general office or medical insurance or 1 year of claims Preprocessing Experience

     

    B.

    ICD9/CPT Coding. Knowledge of medical terminology.

     

    Licenses

    A.

     

     

    B.

     

    Special   Skills

    A.

     

     

    B.

    EPIC Tapestry Experience    

     

    Other

    A.

    Good verbal and written communication skills, professional appearance, positive attitude. Ability to function in a fast paced work environment

     

    B.

    Knowledge of HMO,PPO, and POS Healthplans.

     

    WORKING ENVIRONMENT

    Office

    Options

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