Job DescriptionAdjudicates all claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations. Assists in managing the workflow of assigned Line of Business. Acts as primary department resource for at least one major area of expertise (EDI, Health Plan Repricing, Health Plus Repricing, or HPR).
Required Qualifications:
- Bachelor's Degree In related field or Equivalent experience in Health Care Business Administration.
- 4 years of Managed Care operations, including a minimum of 3 years claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
- Information systems supporting the administration of managed care products.
- IDX healthcare software application.
- CHAMPUS, Medicare and/or Medicaid benefits/programs.
- All areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health, Home Infusion, Kidney Dialysis Centers, Encounters).
- CRT.
Preferred Qualifications: - Microsoft Windows, Word, Excel, and Mail.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
About the TeamPacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
