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Pacific Medical Centers Supervisor USFHP Claims - Uniformed Services Family Health Plan in Seattle, Washington

Description:

Find what you’re looking for in your career, at PacMed as a Supervisor USFHP Claims (1.0 FTE, Day Shift) to work at the Uniformed Services Family Health Plan in Seattle, WA.

The Supervisor USFHP Claims will organize and direct 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.

In this position you will:

  • Set policy for the Claims Department in accordance with the DoD, goals of the department and PMC

  • Assure policy and practice meet NCQA, HCFA and health plan standards

  • Recruit, hires, trains, supervises, coaches, counsels, and evaluates the performance of Claims and Claims Support staff

  • Conduct ongoing training for staff, monitoring current coding guidelines and payment practices to assure accuracy and completeness

  • Conduct audits of staff, meets with staff to review results, sets corrective action plans and provides follow up as needed

  • Design and organizes the training and resource documents used by staff

  • Develop and organizes Policy and Procedure Manual for use in Claims Department and coordinates distribution of information to all departments within the health plan

  • Assist with the design of computer upgrades and enhancements as they apply to the managed care module of Centricity and the code review software module

  • Ensure the organization of the staff in handling the workload and meeting production/accuracy goals

  • Ensure the processing of refunds, special processing requests, adjustment requests, audit research requests, pending claim research, and other special projects

  • Work with Member Services, Enrollment, Patient Accounts, and the Clinic Business Offices to resolve enrollee referral, eligibility, coordination of benefit, and coverage issues

  • Ensure the production of monthly statistics and analytical management reports

  • Direct payment activities performed with Accounts Payable department

  • Ensure that positive and cooperative relationships with the other MCD sections as well as other PMC departments are established and maintained

Qualifications:

Required qualifications for this position includes:

  • Four (4) years of health care claims experience

  • Two (2) years of supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers

Preferred qualifications for this position include:

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

About 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 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: Non-Clinical Director/Executive

Location: Washington-Seattle

Req ID: 322107

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