Job Information

Pacific Medical Centers Reimbursement Specialist - PacMed Seattle, WA - Remote/Hybrid in Seattle, Washington

Description

Monitors the compliance of all major payers with health service contract reimbursement terms and payment provisions. Researches and identifies underpayment patterns and escalates issues to Manager as appropriate. Appeals and resolves insurance underpayments as directed by Manager. Recommends process improvements to maximize coding and billing, and provides support to departments directly responsible for contracting, coding, registration, referral management, revenue posting, and patient financial services. The scope of this position includes patient service revenue generated within Pacific Medical Centers. This position reports to the Revenue Cycle Manager.

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 progressive healthcare business office or health insurance experience.

  • Experience in healthcare financial services.

Preferred Qualification:

  • Associate's Degree, or equivalent from a two-year college or technical school.

Essential Functions:

  • Investigate, research and maintain accurate definitions of contractual rates within SPD contract management system.

  • Utilize and maintain contract management system workflows including external reports to support reimbursement analysis, ensuring that insurance payments are consistent with contractual obligations.

  • Maintain current knowledge regarding reimbursement mechanisms within the healthcare industry.

  • Demonstrate a sophisticated understanding of confidentiality and exercise discretion regarding reimbursement rates and contract terms for various entities as directed by Manager.

  • Develop and maintain effective relationships with provider relations representatives and participate in payer operations meetings when necessary.

  • Identify, communicate and report on underpayment issues, undercharged services, bundling, and other reimbursement opportunities. Work with coding or business office leadership to ensure that corrective action is taken where appropriate.

  • Investigate and research claims variances in SPD contract management system, and pursue recovery of underpayments by compiling and submitting detailed claims appeals as directed by Manager. Work strategically to prioritize projects, and track the status of each appeal, following up with payer representatives as necessary to ensure accurate and timely reprocessing of claims paid incorrectly.

  • Utilize tracking mechanisms to support the interdepartmental coordination of payer compliance related functions and related transactions, such as reason and status coding within payer compliance system.

  • Identify and recommend enhancements for coding, registration, referral management, and any other opportunities that may improve reimbursement, to business office, providers, and clinic operations staff and management. Support implementation of recommended change as necessary.

  • Communicate potential system enhancements and reimbursement process quality improvement opportunities to Manager.

  • Maintain and achieve departmental production measures and standards and goals.

  • Meet deadlines and goals established for underpayment recoveries, including timely and regular follow-up of outstanding appeals and projects.

  • Identify departmental and organizational problems and collaborate with Manager to resolve them.

  • Demonstrate excellent communication skills in either group or individual settings, in verbal and written format. Complete appropriate and timely responses to internal and external customers as they pertain to areas of responsibility.

  • Perform other specific projects or assignments as requested by Manager.

Why Join Providence?

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.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St. John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 242809
Company: Pacific Medical Jobs
Job Category: Reimbursements
Job Function: Finance
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 3060 OTHER FISCAL SERVICES WA
Address: WA Seattle 1200 12th Ave S
Work Location: PACMED Admin Bh-Seattle
Pay Range: $21.54 - $32.31
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.