Ambulatory Service Representative III - The Woodlands

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.  

Performs detailed job requirements of a financial reviewer, patient service representative, PBX operator, appointments clerk and/or medical records clerk.  Performs other duties as assigned by the site manager.

Primary Responsibilities:

• Financial Reviewer - Performs detailed financial review including; Reviewing patient notes. Determining payment source. Determining insurance eligibility and documenting information received by touch‑tone and verification eligibility, fax and/or personal contact with insurance company. Reviewing outstanding balances, analyzing the reason for balance and communicating their findings, as needed, to the patient. Reporting discrepancies to the Patient Account Department or Central Business Office for correction. Utilizing good interpersonal skills when financially counseling patients regarding balances. Reviewing account notes. Documenting accounts to be collected at the time of service in EPIC, including outstanding balances, deductible status, and co‑insurance/co‑pay amounts to be collected. Documents corporate billing information in EPIC. Support the clinical practice by focusing on billing and managed care functions including charge entries, billing edits (work queues), charge reconciliations, responding to billing inquiries, corresponding with insurance carriers, investigating billing discrepancies, etc.) May also support the clinic with front‑desk customer service, patient registration, insurance/coverage verification, patient check in/check out processes
• Ambulatory Service Representative - Provides assistance to patients so that the patient can be processed quickly and efficiently and to ensure that accurate information is obtained and conveyed to the patient including; answering questions and providing suggestions for problem solving and implementing solutions. Assisting registration process or coordinating with the appropriate personnel, directing the patient to the appropriate person/department. Reports internal and external complaints to Coordinator, Supervisor or Clinic Administrator in a timely manner. Actively demonstrates call forwarding to/from the Contact Center at the scheduled times. Takes messages as needed in a complete, concise manner with all required information. Maintains an updated list of all physicians, departmental and internal extensions
• PBX Operator - Answers, screens, screens and directs incoming calls according to PBX standards and procedures. Provides assistance to patients so that patient inquiries can be processed quickly and efficiently to ensure that accurate information is obtained and conveyed to the patient including; referring patients to appropriate departments, relaying information regarding phone wait times, answering questions and providing assistance either directly or by referring them to the appropriate person/department. Reports internal and external complaints to Coordinator, Supervisor or Clinic Administrator in a timely manner. Actively demonstrates call forwarding to/from the Contact Center at the scheduled times. Takes messages as needed in a complete, concise manner with all required information. Maintains an updated list of all physicians, departmental and internal extensions
• Appointment Clerk - Schedules appointments in the computer system following clinic standards and procedures. Schedules ancillary appointments as directed by providers and processes surgeries and forms future appointments one day in advance of appointment or as directed by site management
• Medical Records Clerk - Retrieves and routes all incoming/requested medical records and files back on the appropriate rack to the requesting area as directed by site management. Participates record requests according to established site standards. Follows policy and procedures regarding patient confidentiality. Performs regular internal transportation runs as specified by management. Forwards to ROI with appropriate authorization
• Other duties - As assigned by site management

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.

Required Qualifications:

• High School diploma or GED
• 2+ years medical office experience to include the following: Face to face customer service, cash handling, patient registration, appt. scheduling, medical billing, & experience in answering a multi-line telephone system, OR 1+ years KSC Experience as an Ambulatory Service Representative II
• EMR experience
• Familiarity with medical terminology
• Fluent in English, verbal and written
• MS Word and Excel
• Proven excellent customer service skills in person and over the telephone
• Proven professional demeanor and appearance

Preferred Qualifications:

• Associate or Bachelor's degree in related field
• 3+ years of working in a physician, hospital, or medical office environment
• 2+ years of insurance/managed care experience, to include insurance verification, being able to identify, communicate/articulate and understand the difference between insurance plans (HMO, PPO, EPO, etc.)
• Epic experience
• Demonstrated solid customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues  
• Demonstrated ability to maintain strict confidentiality of all personal/health sensitive information
• Demonstrated ability to effectively handle challenging situations and to balance multiple priorities
• Bilingual- English and Spanish communication skills (oral and written)
• Proven interpersonal skills which are required to interact with internal and external contacts in a courteous and patient focused manner

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20 - $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.