Manager Claims - USFHP
Pacific Medical Centers, Renton, WA, United States
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.
Required Qualifications
Bachelor’s degree or equivalent education/experience, in a healthcare‑related field.
6 years of 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 hierarchical coding experience.
Compensation and Benefits
Pay Range: $50.32 - $79.45. 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.
Additional Information
Requisition 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
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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.
Required Qualifications
Bachelor’s degree or equivalent education/experience, in a healthcare‑related field.
6 years of 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 hierarchical coding experience.
Compensation and Benefits
Pay Range: $50.32 - $79.45. 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.
Additional Information
Requisition 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
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