Lead Claims Specialist - USFHP

Must be an accomplished senior level claims adjudicator with at least 3 years prior claims processing experience and a proven track record of working with IDX software and suggesting workflow, configuration, or coding improvements that directly drive efficiencies and/or quality.  This role is a senior level position and will have responsibility for defining and driving the continuous process improvement cycle for USFHPs instance of Athena IDX software.  This role will work closely with Claims Management and Providence MCA support teams to investigate, document, and write requirements for IDX fixes and product enhancements to drive functional improvements and claims team efficiency. 

The successful candidate in this role will be a proactive, effective communicator who is passionate about quality, training, and helping others achieve.  Must be skilled at working cross functionally, and at all levels of the organization to ensure best practice and adherence to standards at USFHP at all times.  Must be extremely comfortable ready, digesting, interpreting, and creating technical documentation.  Must understand the E2E flow of claims across a HealthPlan organization.  Must be proficient in using Excel/managing data, creating reports, and presenting roadmaps.  This role will regularly need to proactively identify issue/areas of improvement, describe the impact to the business, and propose solutions. 

Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with 9 outpatient clinics and more than 175 primary and specialty care providers in King, Snohomish and Pierce counties. Our patient and staff populations are culturally diverse, creating a stimulating and rewarding workplace. 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 Medical Group. 

Required qualifications:

• Bachelor's Degree A related field. Or Equivalent experience in Health Care Business Administration.
• 4 years Experience in Managed Care operations, including a minimum of 3 years claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
• 1 year Experience performing the core job at Pacific Medical Centers, or equivalent external experience in a lead capacity.
• Experience with information systems supporting the administration of managed care products.
• Experience with IDX healthcare software application.
• Experience in CHAMPUS, Medicare and/or Medicaid benefits/programs required.
• Experience with all areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health, Home Infusion, Kidney Dialysis Centers, Encounters.
• CRT experience.

Preferred qualifications:

• Microsoft Windows, Word, Excel, and Mail experience.

 

Why Join Providence? 

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.  We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

 

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed 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