DescriptionResponsible for maintaining and updating the GE/Centricity/IDX Managed Care Application (MCA) module for US Family Health Plan's managed care line of business: builds fee schedules, provider and vendor dictionary entries, and plan benefits and exclusions. Assists with health plan utilization management reporting for the organization. Responsible for ensuring that optimal payment methodology is in place for payments from US Family Health Plan to vendors and other providers. Responsible for all reports and data transfers to the Department of Defense and its contractors. Provides support for the quality management program.Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.Required Qualifications:
Bachelor's Degree: Related field or
Equivalent experience in Health Care Business Administration as required by URAC
Four years: Minimum of four years’ experience in managed care operations or large group practice setting.
Microsoft SQL Server experience
Must have knowledge of and experience in coding with both CPT and ICD-9 and ICD-10.
Must possess an understanding of financial/administration/clinical business functions and the interfaces/relationships between applications in healthcare.
Preferred Qualifications:
Experience with Access and reporting from a warehouse type database.
Experience with HEDIS reporting desired.
Experience with GE/Centricity/IDX healthcare software application desired.
Clinic setting operations experience highly desirable as complementary experience to the above.
Why Join Providence?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 to advocate, educate and provide extraordinary care.About ProvidenceAt 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 TeamPacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.Providence is proud to be an Equal Opportunity Employer. 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 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.Requsition ID: 279646
Company: Pacific Medical Jobs
Job Category: General Operations
Job Function: Operations
Job Schedule: Per-Diem
Job Shift: Day
Career Track: Business Professional
Department: 3060 WA USFHP
Address: WA Seattle 1226 S Judkins St
Work Location: PACMED Q5-Seattle
Pay Range: $39.15 - $61.81
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 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. Learn more at providence.jobs/benefits
