Kelsey-Seybold

  • Provider Service Representative I- Claims

    Location US-TX-Pearland
    Posted Date 3 weeks ago(11/27/2018 12:17 PM)
    Job ID
    2018-19616
    Category
    Clerical/Administrative Support
  • Overview

    Provider Service Representative I

    Location: Pearland Administrative Office
    Job Type: Full Time

    Department: Claims


    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

    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)

     

    Education

    A.

    High School Diploma

    B.

    Some College

    Experience

    A.

    2 years customer service

    Medical experience

    Medical terminology

    B.

    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

    Licenses

    A.

     N/A

    B.

     

    Special Skills

    A.

    Alpha/Num data entry

    B.

    Strong knowledge of HMO, PPO, and POS plan types a plus with Benefit interpretation

    Other

    A.

    Excellent verbal communications skills and ability to speak english language fluently

    B.

    Spanish speaker

     

    WORKING ENVIRONMENT

    Office

     

    Options

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