Job DescriptionOrganizes and directs the daily activities and department workflow of the Claims Adjudicators and Claims Support Staff under the supervision of the Director of USFHP Operations. Responsibilities include ensuring accurate and timely accounting of Pacific Medical Centers' revenues and expenses for Outside Purchased Services (OPS), timely and accurate processing of claims and materials needed for the adjudication of claims. Assures compliance with DoD and other government agency guidelines and contract requirements. Sets Claims policy and monitors compliance to same. Monitors Medicare and TRICARE coding and payment guidelines and educates staff in changes. Identifies and solves payment issues with outside providers. Serves as the principle contact with IT for Centricity night jobs, check runs and warehouse updates of claims materials. Ensures that delegation standards are met, coordinates monthly reporting and yearly reviews by each plan to assure continued compliance with standards. Manages revisions to the code review software module. Responsible for storage and retrieval of claims and associated paperwork. Serves as a member of the US Family Health Plan management team. Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.
Required Qualifications:- 4 years Health care claims experience.
- 2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers.
Preferred Qualifications:- Bachelor's Degree in Health Care Administration or Business Administration
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.
