Claims Specialist Hybrid - Other Fiscal Services

Description

The Claims Specialist ensures patient account and claim information contains comprehensive and accurate data to provide for timely billing and optimal reimbursement for services.

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.

Essential Functions:

• CUSTOMER SERVICE: Demonstrates professional skills in working with departmental staff, hospital departments, physicians, physician's office staff, government agency and insurance company representatives, patients, consultants and co-workers. Maintains confidentiality of all patient information.
• REGISTRATION AND CHARGING: Ensures all billing documentation required by payers, including but not limited to CPT-4, HCPCS and ICD-10 coding, prior authorization, provider identifications, primary and secondary insurance, patient demographics, insured identification, charges and dates of service are complete and correct. Researches and corrects system and clearinghouse edits.
• BILLING AND RESOLUTION: Performs follow-up with patients and insurance payers to ensure timely and accurate resolution of accounts within departmental guidelines and government program regulations. Works to facilitate resolution of billing and coding inconsistencies. Performs necessary research to facilitate coding requirements in general and for payer specific policies. Researches and resolves insurance denials following the departmental job aids.
• DAILY OPERATION: Demonstrates working knowledge of registration, billing, retrieval, electronic data interchange and online systems, i.e., Registration and Billing Software, Tri-Care/Champus, Medicaid, Medicare, Veterans Administration and Imaging Systems. Possess working knowledge of CPT-4, HCPCS and ICD-9 coding requirements. Responsible for billing, account follow-up, account maintenance, review and analysis of RA's and customer service. Possesses the ability to detect system integrity problems, reports and assist in resolution. Keeps current in rules and regulations as they change.
• COMMUNICATION AND TEAMWORK: Demonstrates professional telephone skills. Demonstrates professional inter-personal skills in communicating with patients and others regardless of age, nationality, or financial situation. Collaborates with team members to achieve a wide range of department specific duties and activities to maintain maximum productivity and success.
• EQUIPMENT: Operates equipment in a safe manner according to department procedures. Operates multiple kinds of equipment. Identifies equipment in need of repairs and informs secretary. Utilizes equipment in the prescribed manner.
• CRITICAL THINKING SKILLS: Utilizes available resources, ie, seeks answer prior to asking for help. example: PPA contracts, government regulatory requirements and guidelines. Recognizes errors/problems and corrects. Analyzes situation and makes a decision within department guidelines.
• ACCURACY AND PRODUCTIVITY: Is self-directed and displays initiative to maintain personal productivity and flexibility. Completes work accurately and according to procedure. Performs work according to department productivity standards.
• COMPLIANCE: Responsible to obtain the necessary knowledge and experience to perform job tasks in compliance with federal, state and local laws, regulations and guidelines. Participates in educational programs and in-services.
• The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position.
• The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position.
• Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies, and standards of their organization.

Required Qualifications:

• 2 years - Experience in healthcare business setting. Education in a related field is accepted in lieu of this work experience.
• 1 year - Experience using EPIC platform.
• 1 year - Successful customer service experience with patients and insurers.

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.

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.

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.

About the Team

Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.

Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.

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: 330926

Company: Pacific Medical Jobs

Job Category: Claims

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Multiple shifts available

Career Track: Admin Support

Department: 3060 OTHER FISCAL SERVICES WA

Address: WA Seattle 1200 12th Ave S

Work Location: PACMED Admin Bh-Seattle

Workplace Type: On-site

Pay Range: $20.50 - $31.48

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.