Manager Claims - USFHP

Job description

This position is responsible for supporting timely, accurate claim processing for the Claims Department, for achieving and maintaining provider coding accuracy and completeness at the levels required by the Corporate Compliance Work Plan,and is responsible for the USFHP Records Management Program. Works directly with providers to educate and monitor their compliance to coding and reimbursement standards. Conducts regular risk assessment audits. Coordination with quality improvement initiatives, supporting ongoing day-to-day production needs, and creative problem-solving are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectations of members, providers, and the Defense Health Agency. Directly manages a non-exempt and exempt team responsible for claim processing. Manages training, documentation and quality assurance activities, as well as coordinating projects related to system upgrades or implementation. 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-focus...