Job description
Overview:
With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.
Kelsey-Seybold Clinic is changing the way health cares. Responsibilities:
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
Education
A.
Associates or Bachelor’s Degree
Experience
A.
2 years experience in a health care environment or insurance environment.
Knowledge of health care and insurance industries and health care delivery systems
Knowledge of Texas Department of Insurance and ERISA Regulations
Excellent interpersonal skills to interface with physicians. Strong ability to actively listen to customers, probe for clarification, and provide consultative guidance based upon customers inquiries.
Ability to use a variety of software applications
Analytical skills to evaluate problems and recommend alternative solutions
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.
B.
Communication
A.
B.
Special Skills
A.
EPIC” Tapestry Experience
A.
WORKING ENVIRONMENT
Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multispecialty clinic with over 25 locations and comprises more than 500 physicians providing primary and specialty care in a collaborative manner.
With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.
Kelsey-Seybold Clinic is changing the way health cares.
Managed Care Representatives respond to inquiries from health plan members, providers and various customers while consistently meeting productivity, quality and service standards. Representatives utilize various internal and external software applications to provide Concierge type services related to health plan operations including benefit interpretation for providers, claims resolution, referral inquiries, general plan benefits, Kelsey-Seybold Clinic information, and enrollment eligibility. Managed Care Representatives handle member and provider calls for self-funded, fully insured and Medicare Commercial plans.
Qualifications:
Managed Care Representative II
Location: Pearland Administrative Office
Department: KelseyCare Operations
Job Type: Full Time
Salary Range: $37,872.80 - $49,708.05 (
Pay is based on several factors including but not limited to education, work experience, certifications, etc
)
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
Education
A.
High School Diploma
B.
Associates or Bachelor’s Degree
Experience
A.
2 years experience in a health care environment or insurance environment.
Knowledge of health care and insurance industries and health care delivery systems
Knowledge of Texas Department of Insurance and ERISA Regulations
Excellent interpersonal skills to interface with physicians. Strong ability to actively listen to customers, probe for clarification, and provide consultative guidance based upon customers inquiries.
Ability to use a variety of software applications
Analytical skills to evaluate problems and recommend alternative solutions
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.
B.
Communication
A.
B.
Special Skills
A.
Strong knowledge of HMOPlan Design and Claims Processing
Managed Care Representatives must build and maintain productive working relationships with various internal and external customers to solve problems systematically using sound business judgment.
Managed Care 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 listening skills
B.
Fluency in Spanish
WORKING ENVIRONMENT
Office
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