Providence
Providence
Providence एक गैर-लाभकारी स्वास्थ्य प्रणाली है, जो प्राथमिक और त्वरित चिकित्सा देखभाल से लेकर बाल चिकित्सा, मातृत्व देखभाल, कैंसर उपचार, न्यूरोसर्जरी और ऑर्थोपेडिक्स तक व्यापक स्वास्थ्य सेवाएँ प्रदान करती है। इसके देखभाल नेटवर्क में प्रत्यक्ष सेवाओं के साथ वर्चुअल अपॉइंटमेंट और मोबाइल ऐप की सुविधा भी शामिल है, जिससे मरीज अपनी आवश्यकताओं के अनुरूप प्रदाताओं से जुड़ सकते हैं। करुणा, गरिमा, न्याय और वंचित समुदायों की सेवा पर केंद्रित Providence जीनोमिक प्रोफाइलिंग और क्लिनिकल परीक्षणों जैसी पहलों के माध्यम से स्वास्थ्य अनुसंधान और नवाचार को भी समर्थन देता है। यह संगठन मरीजों के परिणामों में सुधार लाने और देखभाल तक पहुँच बढ़ाने के लिए क्लिनिकल, संचालन, प्रौद्योगिकी और अनुसंधान टीमों को साथ लाता है।

Senior Claims Processing Specialist

Lead audits, compliance, and training across Providence’s healthcare claims operations. Coordinate with health plans, providers, patients, hospitals, and adjudication teams.

विवरण

  • Oversee internal audits of adjudicated claims and encounters.
  • Check payment runs for accuracy.
  • Create policies and procedures for recurring claims audits.
  • Maintain compliance with health plans, client groups, and administrative contract terms.
  • Develop and lead claims training programs.
  • Update training to reflect changes in policies, procedures, and technology.
  • Promote provider and vendor satisfaction while protecting operational integrity.
  • Coordinate between contracted health plans, patients, hospitals, and the IT department.
  • Provide daily claims compliance guidance and training to Claims Examiners and Adjudication teams.
  • Meet customer-defined quality and responsiveness standards.

आवश्यकताएँ

  • At least five years of professional and facility claims processing experience.
  • Familiarity with applicable state and federal laws governing claim payment and denial timelines.
  • Familiarity with state and federal timeliness compliance rules and regulations.
  • Knowledge of the Provider Dispute Resolution tracking mechanism (AB1455).

लाभ

  • 401(k) retirement savings plan with employer matching.
  • Medical, dental, and vision coverage.
  • Life insurance.
  • Disability insurance.
  • Paid parental leave.
  • Vacation and holiday leave.
  • Time off for health issues.
  • Voluntary benefits.
  • Well-being resources.
  • Additional compensation may include shift differentials, standby or on-call pay, overtime, premiums, extra-shift incentives, or bonuses.

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