Provider Service Representative I
Location: Pearland Administrative Office
Job Type: Full Time
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.
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.
Responsible for calls received from Kelsey-Seybold employees regarding their medical, dental, pharmacy, and vision benefits. Interpret and release information on benefits. Act as liaison between employee and health/pharmacy/dental/vision plan to resolve issues.
Assist in resolution and documentation of patient complaints.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
High School Diploma
2 years customer service
Significant KS related experience (patient account analyst, business office & ASR II)
Previous member service experience with a medical group of health plan
Previous experience with call tracking system
Alpha/Num data entry
Strong knowledge of HMO, PPO, and POS plan types a plus with Benefit interpretation
Excellent verbal communications skills and ability to speak english language fluently