Description

Healthcare Services is looking for a Quality Claim Technician to work from home. What is a Quality Claim Technician? A Quality Claim Technician supports our clinical Nurses and Medical Directors by pre-screening faxes, paper mail, and medical claims to see what can be resolved or in turn elevated for further clinical review. A Quality Claim Technician has a small amount of phone responsibility that communicates directly with various departments and providers offices but the bulk of their work is handled in our Claims and Utilization Management platform. Excellent communications skills and attention to detail are required for this role. We look forward to receiving your application!

Providence is calling a Quality Technician - Medical Management who will:

• Learn all aspects of medical review claims processing, including the Prior Authorization and Concurrent Review post-service components necessary to support the claims work.
• Work incoming paper mail, faxes, and claim inquiry questions on a rotating basis as assigned weekly.
• Minimal phone support for internal and external customers
• Be self-directed with keen deduction and multi-tasking skills, with the ability to learn and work in multiple platforms at one time.
• Solid analytical and critical thinking skills, problem solving, research skills, and data entry skills.
• Meet or exceed standard production goals.
• Act as a resource and provide technical assistance to the nursing staff and medical directors on provider contracts, claims payment procedures, claims research, and department operating procedures.
• Train or re-train staff as necessary based on expertise and experience.
• Work with peers and leadership to resolve service or production problems which can include developing or revising team documentation and workflows.
• Participate in team projects according to expertise and as assigned.
• Coordinate with internal departments to assure accurate and timely provision of service to customers, both internal and external.

We welcome 100% remote work for residents living in the State of Oregon and the City of Vancouver, Washington.

Required qualifications for this position include:

• 3 years' of experience working in health care
• Experience working as a lead or a team member on a project team
• Experience working with database management and spreadsheets

Preferred qualifications for this position include:

• Bachelor's Degree -OR- a combination of equivalent education and experience
• Experience working in a utilization management functional area such as case management, concurrent review, prior authorization, medical audit, appeals or delegation
• 2 years' of experience working in a business environment

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 of caring for everyone, especially the most vulnerable in our communities.

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.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

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.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 166578

Company: Providence Jobs

Job Category: Clinical Quality

Job Function: Quality/Process Improvements

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Beaverton 3601 SW Murray Blvd

Pay Range: $21.57 - $34.30

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.

Check out our benefits page for more information about our Benefits and Rewards.

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate 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.