Full employer posting
Organizes and directs the daily activities and department workflow of the Claims Adjudicators and Claims Support Staff under the supervision of the Director of USFHP Operations. Responsibilities include ensuring accurate and timely accounting of Pacific Medical Centers' revenues and expenses for Outside Purchased Services (OPS), timely and accurate processing of claims and materials needed for the 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. 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
4 years Health care claims experience. 2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers.
Bachelor's Degree in Health Care Administration or Business Administration
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.
Full time · Day shift · 40 hours per week
About the role
Organizes and directs the daily activities and department workflow of the Claims Adjudicators and Claims Support Staff under the supervision of the Director of USFHP Operations.