Supervisor Health Plan Operations - USFHP

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

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 Qualifications:

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

Preferred Qualifications:

• Bachelor's Degree in Health Care Administration or Business Administration

Why Join Providence?

Our best-in-class benefitsare 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 ourmissionto advocate, educate and provide extraordinary care.