About the position
Finding a job that fits your lifestyle isn't always easy. That's where Kelly® comes in. We're seeking a Medical Claims Representative to work at a premier healthcare organization in Houston, TX 77092. In this role, you will be responsible for maintaining workflow inventory on a day-to-day basis to ensure accurate claim determinations. You will process claims timely based on the productivity standard in accordance with contractual and non-contractual processing guidelines. Additionally, you will assist and support other Claim Processors as needed and when requested, completing various work assignments as requested by your supervisor in a timely manner. It is essential to maintain current desk procedures and reference materials while working with claims management in the review of special projects. You may also be required to perform any other assigned duties as necessary. To succeed in this position, you will need to have a High School diploma or equivalent, along with a minimum of 1 year of medical claims adjudication experience in an HMO, PPO, or TPA setting. A solid understanding of medical terminology, CPT/HCPCS and ICD-9/ICD-10 Coding, and billing forms (HCFA/UB04) is crucial. You should possess strong knowledge of Medicare claims processing guidelines and payment methodologies, as well as the ability to follow workflow procedures to release pended claims timely and accurately. Knowledge of Medicare Secondary Payer regulations and strong analytical skills are also required. Basic computer knowledge is necessary to perform the job effectively. Helping you discover what's next in your career is what we're all about, so let's get to work. Apply to be a Medical Claims Representative today! As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan.
Responsibilities
- Maintaining workflow inventory on a day-to-day basis to ensure accurate claim determinations.
- Processing claims timely based on the productivity standard in accordance with contractual and non-contractual processing guidelines.
- Assisting and supporting other Claim Processors as needed and when requested.
- Completing various work assignments as requested by supervisor in a timely manner.
- Maintaining current desk procedures and reference materials.
- Working with claims management in the review of special projects.
- Performing any other assigned duties.
Requirements
- Have a High School diploma or equivalent.
- Have a minimum of 1 year of medical claims adjudication experience in an HMO, PPO, or TPA setting.
- Have an understanding of medical terminology, CPT/HCPCS and ICD-9/ICD-10 Coding, and billing forms (HCFA/UB04).
- Have a strong knowledge of Medicare claims processing guidelines and payment methodologies.
- Have the ability to follow workflow procedures to release pended claims timely and accurately.
- Have knowledge of Medicare Secondary Payer regulations.
- Have strong analytical skills.
- Have basic computer knowledge.
Benefits
- Voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability.
- Access to a retirement savings plan.
- Service bonus and holiday pay plans (earn up to eight paid holidays per benefit year).
- Transit spending account.
- Paid sick leave under the applicable state or local plan.
