Providence Health & Services Claims Specialist 1 - Commercial in Beaverton, Oregon
Providence St. Joseph Health is calling a Claims Specialist - Commercial to Murray Business Center in Beaverton, OR.
In this position you will have the following responsibilities:
Processes all claims entry level to intermediate in all categories in a minimum of one product, as defined by Providence Health Plans.
Processes pends and error codes. Research and resolve pended claims.
Works team reports, 28 day delay report, overpayment reports, retro referral report, retro authorization report, split reports, missing image reports, PPO/no EPO report, daily aging reports, PHS reports, and copayment reports.
Handles incoming mail, provider appeals, inquires, and tracers. Review member correspondence and process or direct to the appropriate department.
Claims processors will work beginning to intermediate Customer Service Inquiries (CSI's). Investigates and responds to department customer service inquiries CSI within company standards
Interpret benefits, payment rules/exceptions, plan documents, literature, and general delivery system requirements.
Identify and research coordination of benefits issues and send to appropriate department.
Required qualifications for this position include:
High school diploma or equivalent
2 years experience with CLAIMS or Customer Service or accounting.
Demonstrated data entry skills, ten-key and PC processing in a Window based environment.
Maintain knowledge of various community and PHS resources to offer. Maintain current knowledge and basic understanding of state or federal assistance programs.
High level of industry knowledge of insurance benefits and internal process flows and provide education to customers regarding insurance benefits and eligibility rules.
Strong customer service skills.
Familiarity with eligibility and enrollment rules and practices.
Familiarity with premium billing processes, accounts receivable, and collections.
Knowledge of web based applications.
Knowledge of the following office equipment/programs; Personal computer, Fax machine, Multi-line telephone in ACD group, Telephone headset, Copier, 10-key calculator, Printer, Facets, Internet, Various ancillary systems, Databases and Software.
Preferred qualifications for this position include:
Basic medical terminology, CPT codes, ICD-9 & ICD-10 coding
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.
We offer a full comprehensive range of benefits - see our website for details
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 Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. 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: Health Plan/Insurance Nursing
Req ID: 210668