Providence
Providence
„Providence“ yra pelno nesiekianti sveikatos priežiūros sistema, teikianti platų sveikatos priežiūros paslaugų spektrą – nuo pirminės ir skubiosios pagalbos iki pediatrijos, motinystės priežiūros, vėžio gydymo, neurochirurgijos ir ortopedijos. Jos priežiūros tinklas apima paslaugas vietoje, nuotolines konsultacijas ir prieigą per mobiliąją programėlę, todėl pacientai gali susisiekti su sveikatos priežiūros specialistais jiems patogiais būdais. Vadovaudamasi užuojautos, orumo, teisingumo ir pagalbos pažeidžiamoms bendruomenėms principais, „Providence“ taip pat remia sveikatos priežiūros mokslinius tyrimus ir inovacijas, įgyvendindama tokias iniciatyvas kaip genominis profiliavimas ir klinikiniai tyrimai. Organizacija telkia klinikines, veiklos, technologijų ir tyrimų komandas, siekiančias gerinti pacientų gydymo rezultatus ir plėsti prieigą prie priežiūros.

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.

Aprašymas

  • 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.

Reikalavimai

  • 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).

Privalumai

  • 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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