Tapestry SME Research Analyst - Kelsey Seybold Clinic

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.

Primary Responsibilities:

• Conduct departmental training and one-on-one-end user development sessions
• Support claims testing, troubleshooting and research relative to vendor, provider & benefit build, including referrals associated with the overall claims adjudication process
• Subject Matter Expert in facility and professional claims adjudication
• Support claims testing relative to system build including vendor/provider contracts and benefit build, upgrades, implementation, software and Epic Systems (Tapestry) usage
• Create test scenarios to support administrative workflows, data collection, error analysis and corrections and provide written summary of research/findings to Claims Department Leadership
• Support all auditing/quality performance initiatives
• Maintain in depth knowledge of Epic Tapestry Systems and software, serve as liaison, identifying both user and system issues during testing and research
• Perform adjudication of facility and professional claims as assigned
• Resolution of assigned claim projects
• Other duties as assigned

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 from an accredited program with equivalent industry experience
• 5+ years of claims adjudication experience or 2+ years of Claims Q/A or supervisory experience
• Proven knowledge of Managed Care Product including contract knowledge
• Demonstrated familiarity with reimbursement methodologies, CPT codes and ICD-9, ICD-10. HCPCS, DRG, Revenue Codes
• Proficient use of Microsoft products including Excel, Word, Power Point
• Proven solid understanding of the Accountable Care model
• Demonstrable knowledge of clinical data sets (CPT, HCPCS, ICD-9, ICD-10, etc.)
• Proficiency with Microsoft Word, Excel, and familiar with Access and Power Point
• Valid Texas Driver's License

Preferred Qualifications:

• Demonstrated public speaking and presentation skills
• Proven excellent written and oral communication skills
• Reporting experience

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 $20.38 to $36.44 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.