Providence
Providence
Providence je neprofitni zdravstveni sistem, ki zagotavlja širok nabor zdravstvenih storitev, od osnovne in urgentne oskrbe do pediatrije, porodniške oskrbe, zdravljenja raka, nevrokirurgije in ortopedije. Njegova mreža zdravstvene oskrbe združuje storitve v živo z virtualnimi obiski in dostopom prek mobilne aplikacije ter pacientom pomaga vzpostaviti stik z izvajalci zdravstvenih storitev na način, ki ustreza njihovim potrebam. Providence, ki ga vodijo načela sočutja, dostojanstva, pravičnosti in služenja ranljivim skupnostim, podpira tudi zdravstvene raziskave in inovacije s pobudami, kot sta genomsko profiliranje in klinična preskušanja. Organizacija povezuje klinične, operativne, tehnološke in raziskovalne ekipe, ki si prizadevajo izboljšati izide zdravljenja pacientov in razširiti dostop do zdravstvene oskrbe.

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.

Opis

  • 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.

Zahteve

  • 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).

Ugodnosti

  • 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.

Sorodna delovna mesta

Sedgwick

Senior Liability Claims Examiner – General Liability, Bodily Injury and Property Damage

Sedgwick

Examine commercial trucking, general liability, bodily injury, property damage, and construction defect claims for Sedgwick. Handle claims across the United States, with particular focus on California, Florida, and New York.

Odpri