Providence Health & Services Claims Manager in Beaverton, Oregon
Providence St. Joseph Health is calling a Claims Manager to our location in Beaverton, OR.
We are seeking a Claims Manager who will be responsible for supporting timely, accurate claim and encounter processing for the claims service teams for all lines of business. Direct reports include exempt and non-exempt staff. Coordination with quality improvement initiatives, supporting ongoing day-to-day production needs, and creative problem-solving are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectations of members, providers, employer groups, regulators and auditors. Directly manages a non-exempt and exempt team responsible for claims data entry, as well as exempt professionals performing quality audits, financial research and adjustments. Manages training, documentation and QA activities, as well as coordinating large reprocessing projects. This position also is accountable for meeting and maintaining Compliance with Regulatory and Accreditation related to claims payment and accuracy standards.
In this position you will have the following responsibilities:
Accountable for daily routines of workflow, work assignment in support of the department goals. Monitors appropriate coverage and performance, takes corrective action to meet established standards.
Assures continuous improving workflow processes , identify needs, makes recommendations, and takes action.
Assigns and manages and handles special projects delegated by claims director.
Supervises one Supervisor with direct reports. Provides guidance and mentors supervisor.
Coordinate claim testing activities for system upgrades, conversions, and projects.
Achieve organization's performance standards for the following work processes: a) claims turnaround b) claim payment accuracy c) claims statistical accuracy d) receipt of EDI claims e) budgeted administrative expenses
Coordinate and expedite large claim reprocessing projects.
Prepares budget annually.
Monitors EDI claim submission and pass rates, partnering with Provider Relations and IS staff to maximize both.
Collaborate with the Training Team to develop training curricula for staff to stay current, to increase knowledge, and to become cross-functionally proficient.
Manage coordination of all work, quality improvement activities, projects, objectives, and staffing of the department by working with the other Service Operations Managers. Manage and oversee the implementation of new initiatives that impact the team including but, not limited to quality initiatives, automation of initiatives, new products, and geographic expansion and other growth opportunities.
Provide a supportive, team-based environment that facilitates group decision making and employee empowerment.
Evaluate performance and initiate personnel actions such as hiring, merit increases, probationary and periodic reviews, promotions, transfers between teams, and disciplinary actions. Provides coaching and support for the team that promotes accountability, excellence, and facilitates productivity, continuous improvement and development for caregivers.
Foster professional relationships with Manager peers in Provider Relations, Health Care Services, Pharmacy, Product, Communications, Information Services, and Risk & Reimbursement.
Work with peers on new products, benefit changes, and new lines of business in order to establish service team coverage as well as the necessary system changes.
Lead or participate in Projects involving the claims teams.
Although incumbent will be primarily responsible for a particular product line, they will be expected to have a working knowledge of all lines of business and other Service Operations functions.
Required qualifications for this position include:
- 6 years operational experience, Customer service or Claims experience.
Preferred qualifications for this position include:
Bachelor's Degree or 4 years experience.
Associate Degree or 6 years of related management/industry experience or equivalent education/experience.
6 years supervisory experience.
Demonstrated project management skills.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate 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.
Job Category: Non-Clinical Lead/Supervisor/Manager
Req ID: 291552