Responsibilities
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.
Job Title: Managed Care Representative II
Location: Pearland Administrative Office
Department: Member Provider Service
Job Type: Full Time
Salary Range: $42,697 - $52,744 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications
Education
Required: High School Diploma
Preferred: Associates or Bachelor's Degree
Experience
Required: 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
Preferred: 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.
License(s)
Required: N/A
Preferred: N/A
Special Skills
Required: 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.
Preferred: EPIC" Tapestry Experience
Other
Required: Excellent communication and listening skills
Preferred: Fluency in Spanish
Working Environment: Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston's fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
Medical, Vision, and Dental
Tuition Reimbursement
Company Matching 401K
Employee Reward and Recognition Program
Paid time off for vacation, sick, and holidays
Employee Assistance Program
Continuing Medical Education allowance
Kelsey-Seybold Clinic strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by organizational policy or by federal, state, or local laws unless such distinction is required by law. Kelsey-Seybold is a VEVRAA Federal Contractor and desires priority referrals of protected veterans.
