Managed Care Representative II

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 HMO Plan 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

Managed Care Representative II

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