Financial Reviewer II
Kelsey-Seybold Medical Group

Overview

Financial Reviewer II

Location: Pearland Administrative Office

Department:

Job Type:

COMPANY PROFILE

Kelsey-Seybold Clinic. Changing 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.

JOB SUMMARY

Under the supervision of the Administrative Supervisor/Clinic Administrator, the Guarantor Account Analyst researches assigned guarantor accounts and resolves billing issues by contacting patients/insurance carriers regarding outstanding balances (patient contact includes phone and face-to-face interaction). The ability to audit and reconcile an account is critical to this position, with aged guarantor balances representing over one million dollars in outstanding revenue annually. Interprets plan benefits in relationship to area of responsibility for Specialty Care Services (i.e. OBGYN, Orthopedics) and uses strong interpersonal/persuasive abilities in order to secure accurate and timely account resolution. Maintains effective communication and professional interaction with patients, physicians and fellow co-workers. Conducts duties in accordance with industry standards and in compliance with department policy & procedure. Must be able to meet Operations standards for established production and quality standards. Must also demonstrate understanding of correct adjudication relative to assigned Specialty Care services (i.e. OBGYN, Orthopedics) and have a proven track record of additional reimbursement from insurance carrier as well as from guarantor.

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

Associates Degree or 2 years' experience equivalence.

B.

1-year college, successful completion of Medical Billing & Coding class.

Experience

A.

Five - seven years medical office collections (both self-pay and insurance) with guarantor account follow-up, successful appeals outcomes and the ability to interpret plan benefits/payment methodology by primary and secondary health plans.
OR two years similar experience with an Associate or higher degree.

B.

1-year KSC Epic practice management system experience.

Licenses

A.

B.

Certified/Licensed Medical Billing

Special Skills

A.

Basic PC Literacy. Alpha/Num Forms Entry. Medical Terminology, CPT & ICD coding experience. Use of physician billing systems and interpretation of Explanation of Benefits (EOB's). Detailed knowledge of healthcare insurance to include diversified understanding of rules and regulations of Commercial Insurance with appeals experience (claims denials). Analytical skills to include interpretation of guarantor account balances with problem resolution. Excellent telephone etiquette with demonstrated capability to meet with patients one-on-one and explain payment methodology by the insurance carrier. Ability to work independently and display teamwork qualities among peers and other department personnel. Ability to train front desk staff on interpreting guarantor account activity.

B.

Proficiency in Microsoft Word and Excel.

Other

A.

Excellent interpersonal communications skills and strong written and verbal communication skills for staff and patient interaction. Must be able to work independently and be self-directed/able to absorb new material quickly. Able to utilize Microsoft products (Excel and Word).

B.

Ability to handle a variety of tasks with speed and attention to detail.



WORKING ENVIRONMENT

Office