Claims Verification Operator
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.
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)
High School Diploma or GED
2 years of general office or medical insurance or 1 year of claims Preprocessing Experience
ICD9/CPT Coding. Knowledge of medical terminology.
EPIC Tapestry Experience
Good verbal and written communication skills, professional appearance, positive attitude. Ability to function in a fast paced work environment
Knowledge of HMO,PPO, and POS Healthplans.