Pacific Medical Center Jobs

Job Information

Pacific Medical Centers Claims Adjudicator - Uniformed Services Family Health Plan *Up to $2,000 Hiring Bonus* in Seattle, Washington

Description:

Claims Adjudicator

Adjudicates 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.

Qualifications:

Required qualifications:

  • H.S. Diploma or GED -or- equivalent experience in Health Care Business Administration

  • Two (2) years experience in Managed Care operations

  • One (1) year Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting

  • Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters)

  • Information systems supporting the administration of managed care products

  • Typing and 10-key skills (40 wpm and 100 spm) and CRT experience

Preferred qualifications:

  • IDX healthcare software application.

  • CHAMPUS, Medicare and/or Medicaid benefits/programs

  • Has an understanding of the principles, theories, and practices of benefit design, plan inclusions and exclusions, healthcare administration rules and regulations, subrogation, third party liability, reinsurance, and coordination of benefits

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.

Pacific Medical Center:

Pacific Medical Center is an expanding network of outpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties.

Pacific Medical Centers is affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time, Pacific Medical Centers and Providence offer diverse locations, lifestyles and practice models. Find what you are looking for in your next practice opportunity with Pacific Medical Centers! Learn more at www.pacmed.org/providerjobs .

We offer a full comprehensive range of benefits — see our website for details — http://pacmed.jobs/benefits/

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit https://pacmed.jobs/benefits/

Our Mission

Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.

About Us

Quality and respect. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 10 outpatient clinics across the Puget Sound region and more than 175 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”

Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Schedule: Full-time

Shift: Day

Job Category: Claims

Location: Washington-Seattle

Req ID: 352462

DirectEmployers