Supervisor Health Plan Operations - USFHP

Responsibilities

• Ensures accurate and timely accounting of Pacific Medical Centers' revenues and expenses for Outside Purchased Services (OPS).
• Timely and accurate processing of claims and materials needed for the adjudication of claims.
• Affirms compliance with DoD and other government agency guidelines and contract requirements.
• Sets Claims policy and monitors compliance to same.
• Maintains awareness of Medicare and TRICARE coding and payment guidelines and educates staff in changes.
• Solves payment issues with outside providers.
• Serves as the principle contact with IT for Centricity night jobs, check runs, and warehouse updates of claims materials.
• Manages revisions to the code review software module.
• Responsible for storage and retrieval of claims and associated paperwork.
• Serves as a member of the US Family Health Plan management team.
• Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.

  Requirements

  • 4 years Health care claims experience.
  • 2 years Supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers.

  Qualifications

  • Bachelor's Degree in Health Care Administration or Business Administration.

  Benefits

  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.