Manager Claims - USFHP

Description

This position is responsible for supporting timely, accurate claim processing for the Claims Department, for achieving and maintaining provider coding accuracy and completeness at the levels required by the Corporate Compliance Work Plan,and is responsible for the USFHP Records Management Program. Works directly with providers to educate and monitor their compliance to coding and reimbursement standards. Conducts regular risk assessment audits. Coordination with quality improvement initiatives, supporting ongoing day-to-day production needs, and creative problem-solving are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectations of members, providers, and the Defense Health Agency. Directly manages a non-exempt and exempt team responsible for claim processing. Manages training, documentation and quality assurance activities, as well as coordinating projects related to system upgrades or implementation.

Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

• Bachelor's degree Or equivalent education/experience, in a healthcarerelated field.
• 6 years Health care experience in a physician group practice or other ambulatory care setting.
• 4 years Supervisory experience
• 3 years Conducting provider education and audits.

Preferred Qualifications:

• 5 years Coding experience for a multi-specialty group.
• 1 year HCC hierarchal coding 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.

About Providence

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.

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.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Requsition ID: 427108

Company: Pacific Medical Jobs

Job Category: Claims

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 3060 WA USFHP

Address: WA Renton 620 Naches Ave SW

Work Location: Blackriver Corporate Park-Renton

Workplace Type: Hybrid

Pay Range: $50.32 - $79.45

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.