Supervisor Health Plan Operations - USFHP

Providence • Renton, WA

9d

About The Position

Organizes and directs daily activities and department workflows to ensure accurate claims adjudication and payment integrity processes under the supervision of the Director of USFHP Health Care Operations. Responsibilities include ensuring accurate and timely accounting to Pacific Medical Center’s revenues and expenses for Outside Purchased Services (OPS), timely and accurate processing of claims and materials needed for accurate adjudication of claims. The ideal Supervisor will have experience with medical coding and claim auditing. 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. 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. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

Requirements

• 4 years Health care claims experience
• 2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers

Nice To Haves

• Bachelor's Degree in Health Care Administration or Business Administration
• Experience with medical coding and claim auditing

Responsibilities

• Organizes and directs daily activities and department workflows to ensure accurate claims adjudication and payment integrity processes
• Ensuring accurate and timely accounting to Pacific Medical Center’s revenues and expenses for Outside Purchased Services (OPS)
• Timely and accurate processing of claims and materials needed for accurate 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

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