Supervisor Health Plan Operations - USFHP
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At a glance
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Job overview
Pacific Medical Centers is hiring a Supervisor Health Plan Operations - USFHP. The Supervisor Health Plan Operations organizes and directs daily activities and workflow for Claims Adjudicators and Claims Support Staff. This role ensures accurate and timely accounting of revenues and expenses for Outside Purchased Services, processes claims, and assures compliance with DoD and government agency guidelines. The supervisor sets claims policy, monitors compliance, and educates staff on Medicare and TRICARE coding changes. They also manage revisions to code review software and serve as a member of the US Family Health Plan management team.
Key focus areas include Organize and direct daily activities and department workflow of Claims Adjudicators and Claims Support Staff, Ensure accurate and timely accounting of Pacific Medical Centers' revenues and expenses for Outside Purchased Services (OPS), and Ensure timely and accurate processing of claims and materials needed for adjudication of claims.
Successful candidates bring Health Care Claims Experience and Supervisory Capacity. Preferred (not required): Organizing Daily Activities, Directing Department Workflow, Ensuring Accurate Accounting, and Timely Processing Of Claims.
Skills & qualifications
Skills
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Full job description
Description
Organizes and directs 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.
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:
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4 years Health care claims experience.
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2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers.
Preferred Qualifications:
- Bachelor's Degree in Health Care Administration or Business Administration
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.
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.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts 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.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 446527 Company: Pacific Medical Jobs Job Category: Member Services Enrollment & Billing Job Function: Health Plans Services Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 3060 WA USFHP Address: WA Renton 620 Naches Ave SW Work Location: Blackriver Corporate Park-Renton Workplace Type: Hybrid Pay Range: $39.45 - $61.24 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.
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