Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs and implements claims training programs for the organization, to include adaptations to changes in policies, procedures and technologies. Must be familiar with applicable State and Federal claim payment and denial timeliness legislation. Must be familiar with Timeliness Compliance pursuant to State and Federal rules and regulations. Must be well versed regarding the Provider Dispute Resolution tracking mechanism (AB1455).
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:
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.
Every day, 119,000 compassionate caregivers serve patients and communities through Providence St. Joseph Health, a national, Catholic, not-for-profit health system, driven by a belief that health is a human right.
Rooted in the founding missions of the Sisters of Providence and the Sisters of St. Joseph of Orange, courageous women ahead of their time who brought health care and other social services to the American West when it was still a rugged, untamed frontier, we share a singular commitment to improve the health of all.
From our earliest days, we’ve met new challenges by pioneering new solutions. Today, with 51 hospitals, 829 clinics and a comprehensive range of services, we strive to meet the needs of communities across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington through a diverse family of Catholic, other faith-based and mission-driven secular organizations.
Now, as we face a new frontier—a changing health care landscape—we draw upon their pioneering and compassionate spirit to plan for the next century of health for a better world, especially for the poor and vulnerable.
If you need treatment, please visit www.providence.org to locate a health care provider.
