Optum
Financial Reviewer II - Kelsey Seybold Clinic: Main Campus
Optum, Houston, Texas, United States, 77001
Explore Opportunities With Kelsey-Seybold Clinic
Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing Together. Primary Responsibilities:
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. Required Qualifications:
High school diploma 5+ years of medical office collections experience (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 Basic PC Literacy, Alpha/Num Forms Entry, Medical Terminology, CPT & ICD coding experience and 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 Excellent interpersonal communications skills and strong written and verbal communication skills for staff and patient interaction Ability to work independently and be self directed/able to absorb new material quickly Ability to utilize Microsoft products (Excel and Word) Preferred Qualifications:
Successful completion of Medical Billing & Coding class Certified/Licensed Medical Billing 1+ years of KSC Epic practice management system experience Proficiency in Microsoft Word and Excel Ability to handle a variety of tasks with speed and attention to detail Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing Together. Primary Responsibilities:
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. Required Qualifications:
High school diploma 5+ years of medical office collections experience (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 Basic PC Literacy, Alpha/Num Forms Entry, Medical Terminology, CPT & ICD coding experience and 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 Excellent interpersonal communications skills and strong written and verbal communication skills for staff and patient interaction Ability to work independently and be self directed/able to absorb new material quickly Ability to utilize Microsoft products (Excel and Word) Preferred Qualifications:
Successful completion of Medical Billing & Coding class Certified/Licensed Medical Billing 1+ years of KSC Epic practice management system experience Proficiency in Microsoft Word and Excel Ability to handle a variety of tasks with speed and attention to detail Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.