Senior Claims Specialist - USFHP

Pacific Medical Centers; Renton (WA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

401(k) savings plan with employer matching

Health care benefits (medical, dental, vision)

Paid time off

Job summary

Pacific Medical Centers in Renton, Washington is looking for an experienced claims adjudicator to manage and resolve complex claims. The ideal candidate will have a Bachelor's Degree in a related field and at least 4 years of Managed Care operations experience.

This role involves adjusting claims, responding to customer service requests, and serving as a primary resource for the department. Our benefits include a 401(k) plan, health care benefits, and paid time off.

Qualifications

• Bachelor's Degree in a related field or equivalent experience in Health Care Business Administration.
• 4 years of Managed Care operations, including a minimum of 3 years claims processing experience.
• Experience with IDX healthcare software application.

Responsibilities

• Adjudicates claims submitted by outside purchased services.
• Adjusts complex claims for advanced processing needs.
• Acts as primary department resource for major areas of expertise.

Skills

Claims processing

Managed Care operations

Information systems

IDX healthcare software

Knowledge of Medicare/Medicaid

Education

Bachelor's Degree in Health Care Business Administration

Tools

Microsoft Windows

Microsoft Word

Microsoft Excel

Microsoft Mail

Job description

Responsibilities

Adjudicates all claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations. Assists in managing the workflow of assigned Line of Business. Acts as primary department resource for at least one major area of expertise (EDI, Health Plan Repricing, Health Plus Repricing, or HPR).

Qualifications

• Bachelor's Degree in a related field or equivalent experience in Health Care Business Administration.
• 4 years of Managed Care operations, including a minimum of 3 years claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
• Experience with information systems supporting the administration of managed care products.
• Experience with IDX healthcare software application.
• Knowledge of CHAMPUS, Medicare and/or Medicaid benefits/programs.
• Experience with all areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health, Home Infusion, Kidney Dialysis Centers, Encounters).
• CRT.

Preferred Qualifications

• Proficiency in Microsoft Windows, Word, Excel, and Mail.

Benefits

Our benefits program includes retirement 401(k) savings plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, paid time off, and other voluntary benefits.

Equal Employment Opportunity

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.