Claims Recovery Analyst
Location: Pearland Administrative Office
Department: KS Plan Advantage- Claims
Job Type: Full Time
Kelsey-Seybold Clinic. Chaning the way health cares.
Kelsey-Seybold Clinic is Houston's premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey. With 21 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.
This position requires research of all Claims when suspended for dual coverage, pre-existing research, and coordination of benefits investigation. Analyst will apply coordination of benefits procedures to claims with confirmed dual coverage via use of the Epic Systems. Add/modify filing order information in EPIC System as well as documenting COB information in the system. Refund posting via EPIC system. Prepare monthly summary and forward payments received to accounting department.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
High School diploma or GED from an accredited program
Knowledge of Direct Provider Network Product.
2 years of Managed Care Experience in Claims Administration with KSC as Claims Analyst or Provider Service Representative or 3 years of claims payment/coordination of benefits experience in another Healthcare environment.
Self directed and able to absorb new information quickly. Knowledge of ICD-9, CPT Codes. 1 year of Claims Collections/Recovery Experience.
Understanding and interpretation of Managed Care claims payment process including electronic claims adjudication, contractual agreements, Financial Obligation Summaries, L.O.A.' s, Medicare/HCFA guidelines, Coordination of Benefit rules, State mandated processes specific to recovery and claims payment requirements. (Senate Bill 418).
Knowledge and use of Microsoft products (Word/Excel).
Knowledge of Direct Provider Network Product
Knowledge of EPIC System.
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