Health Plan Operations Supervisor: Claims & Compliance Leader

Providence; Renton (WA); On-site; USD 90,000 - 130,000; Full time

Job summary

Providence is seeking a Claims Adjudication Supervisor to organize and direct the daily activities and workflow of the Claims Adjudicators and Support Staff under the supervision of the Director of USFHP Operations. The role ensures timely processing of claims and adherence to government guidelines, while managing budget responsibilities.

Responsibilities include monitoring Medicare/TRICARE coding, handling payment issues with outside providers, and coordinating with IT for Centricity night jobs

Qualifications

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

Responsibilities

• Organizes daily activities and department workflow of the Claims Adjudicators and Support Staff under the Director of USFHP Operations.
• Ensures accurate and timely accounting of revenues and expenses for Outside Purchased Services (OPS).
• Monitors compliance with DoD and government guidelines and contract requirements; coordinates monthly reporting and yearly reviews.

Education

Bachelor's Degree in Health Care Administration or Business Administration

Job description

Providence is seeking a Claims Adjudication Supervisor to organize and direct the daily activities and workflow of the Claims Adjudicators and Support Staff under the supervision of the Director of USFHP Operations. The role ensures timely processing of claims and adherence to government guidelines, while managing budget responsibilities.

Responsibilities include monitoring Medicare/TRICARE coding, handling payment issues with outside providers, and coordinating with IT for Centricity night jobs