Providence Health & Services Quality Medical Management Technician in Oregon
Providence St. Joseph Health is calling a Health Care Services (HCS) Technician to our location in Beaverton, OR. This position will be remote may require some office meetings on occasion. We are seeking candidates preferably that are available in commute distance to the office in Beaverton, OR.
We are seeking a Health Care Services Claims Technician to be responsible for providing services for and improving the quality and productivity. The work focuses mainly around medical review claims auditing. The Claims Technician uses a global approach to assure core activities and functional areas are integrated and linked to achieve the highest outcomes for our customers both internal and external. This job focuses on technical, analytical, and organizational support for the Health Care Services department.
In this position you will have the following responsibilities:
Self-directed with keen deduction and superior multi-tasking skills, which includes pended claims and authorizations for appropriate payment determination based on assessment of complex information, such as contract language, provider status, payment guidelines, risk designation and system setup.
Meet or exceed standard production goals.
Act as a resource and provides technical assistance to the nursing staff and medical directors on provider contracts, claims payment procedures, claims research, and department operating procedures.
Ability to learn and work in multiple platforms at one time.
Train or re-train staff as necessary based on expertise, experience, action plans, external changes, or demands (regulatory or product).
Work with peers and others 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.
Minimal phone support for internal and external customers
Coordinate with internal departments to assure accurate and timely provision of service to customers.
Required qualifications for this position include:
Current state registration, license, or certification as appropriate to education
3 years health care experience
Experience as lead or team member on a project team
Experience in database management and spreadsheets
Preferred qualifications for this position include:
Bachelor's Degree or 5 years of work experience in related field.
2 years business environment experience
Experience in a utilization management functional area such as case management, concurrent review, prior authorization, medical audit, appeals or delegation.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. 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.
Job Category: Quality/Risk/Safety (Non-Clinical)
Other Location(s): Oregon
Req ID: 325937