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    Senior Claims Specialist - Los Angeles, United States - PROVIDENCE, INC.

    PROVIDENCE, INC.
    PROVIDENCE, INC. Los Angeles, United States

    2 weeks ago

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    Description

    Description

    The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary.

    Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.

    Providence caregivers are not simply valued - they're invaluable.

    Join our team at Providence Medical Foundation 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:

    • 2 years of Claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
    • Experience processing all types of medical claims outpatient/inpatient UB-04 and HCFA-1500 claims as well as others.

    Preferred Qualification:

    • Experienced in interpreting provider contract reimbursement terms.

    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 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 Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care.

    Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

    PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St.

    John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

    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: 261029


    Company: Providence Jobs


    Job Category: Claims


    Job Function: Revenue Cycle


    Job Schedule: Full time


    Job Shift: Day


    Career Track: Admin Support


    Department: 7520 CLAIMS PROCESSING CA HERITAGE SERVICES

    Address: CA Mission Hills 11165 N Sepulveda Blvd

    Work Location: Facey Sepulveda Annex-Mission Hills


    Pay Range: $ $40.23

    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.

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