Kelsey-Seybold

  • Member Services Representative II

    Location US-TX-Pearland
    Posted Date 1 week ago(1 week ago)
    Job ID
    2018-19233
    Category
    Clerical/Administrative Support
  • Overview

    Member Services Representative II


    Location: Pearland Administrative Office


    Department: Kelseycare Operations
    Job Type: Full Time


     


    COMPANY PROFILE


    Kelsey-Seybold Clinic. Your Doctors for Life.


    Kelsey-Seybold Clinic is Houston’s premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey.  With 19 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center.  Our mission is to provide our team members with exceptional opportunities for professional and personal growth.


     


     JOB SUMMARY


    Member Service Representatives II are required to provide a high level of services to members of the health plan which include providing detail information regarding health plans benefits, assisting and facilitation of services such as appointments and  transportation, direction to providers and services associated with the member’s health plan.  Obtain responses to various required surveys and promote member retention and growth initiatives. 


     


     


    EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS


    (A = basics; B = preferred)









































    Education



    A.



    High School Diploma



    B.



    Associates or Bachelor’s Degree



    Experience



    A.



    3-5 years of experience   in a health care  insurance environment or 1 Year Experience as a  Member   Service Rep I at KelseyCare Advantage or    6 months – 1 year experience as a KelseyCare Advantage Health Plan   Representative or KelseyCare Advantage Sales Coordinator


     


    Knowledge of health care and insurance and the ability to Interpret/Apply Medicare   Prescription Drug Benefits, Medical Benefit Interpretation, CMS Regulations,   Texas Department of Insurance Regulations and ERISA


     



    B.



    Previous Experience with   a call documentation system


     


    Knowledge of Medical Terminology


     


    Ability to Work in a Fast Paced Continuously Changing Environment


     


    Knowledge of CPT and ICD9 Codes


     


    Ability   to understand complex oral and written directions and technical information.


     



    Licenses



    A.



    N/A



    B.



     



    Special   Skills



    A.



    Strong   knowledge of  HMOPOS and TPA Plan   Design and Claims Processing


     


    Member   Service Representatives must build and maintain productive working   relationships with various internal and external customers to solve problems   systematically using sound business judgment.   



    B.



     


    “EPIC” Tapestry Experience



    Other



    A.



    Excellent   communication and telephone etiquette, Problem Solving  and active listening skills


     


    Representative   II are required to pass knowledge testing and maintain positive Quality and   Production Scores.



     



    Spanish Speaker



     


     


    WORKING ENVIRONMENT


    Office

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