Manager Claims - USFHP

Providence • Renton, WA

3d

About The Position

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.

Requirements

• Bachelor’s degree Or equivalent education/experience, in a healthcare‑related 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.

Nice To Haves

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

Responsibilities

• supporting timely, accurate claim processing
• achieving and maintaining provider coding accuracy
• USFHP Records Management Program
• educate and monitor compliance to coding and reimbursement standards
• Conduct regular risk assessment audits
• Coordination with quality improvement initiatives
• supporting ongoing day-to-day production needs
• creative problem-solving
• continuous improvements in production, efficiency, quality and automation
• 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
• coordinating projects related to system upgrades or implementation

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 501-1,000 employees