Financial Reviewer II - Kelsey-Seybold Clinic - Main Campus

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. 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. 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. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

High school diploma 5+ 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 2 years similar experience with an Associate or higher degree 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) Able to utilize Microsoft products (Excel and Word) Proven analytical skills to include interpretation of guarantor account balances with problem resolution Proven ability to work independently and display teamwork qualities among peers and other department personnel Proven ability to train front desk staff on interpreting guarantor account activity Proven ability to work independently and be self directed/able to absorb new material quickly Proven excellent telephone etiquette with demonstrated capability to meet with patients one-on-one and explain payment methodology by the insurance carrier Proven excellent interpersonal communications skills and strong written and verbal communication skills for staff and patient interaction Preferred Qualifications: Certified/Licensed Medical Billing 1+ years of college, successful completion of Medical Billing & Coding class 1+ years of KSC Epic practice management system experience Proficiency in Microsoft Word and Excel Proven 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,