Senior Claims Specialist - Claims Processing
About The Position
The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation 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
- 2 years Claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment
- Experience processing all types of medical claims outpatient/inpatient UB-04 and HCFA-1500 claims as well as others
- Knowledge of compliance issues as they relate to claims processing
Nice To Haves
- Interpreting provider contract reimbursement terms
Responsibilities
- Processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.)
- Adjudication and claims research when necessary
- Identify and address non-contracted providers
Benefits
- Best-in-class benefits uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
