Claims Examiner jobs in Santa Rosa, CA

Description

Claims Appeals Representative - 100% Remote. We welcome residents in our footprint states, AK, CA, OR, WA, TX, NM, or MT

The Claims Appeals Representative position is responsible for day to day review, coordination and management of technical denials requiring background and understanding from a provider operational and payer logistical perspective. Works closely with the Clinical Denial RN and support staff to review denied accounts, prepare rebuttals, discuss denials with payer representatives and monitor outcomes of follow-up activities. Works closely with the Clinical Denial RN on nuances associated with denials of a clinical nature. Additionally, works closely with Ministry Liaisons within RCS, assuring that payer contracts and Ministry protocols are followed, to promote the development of ongoing value added relationships and sacred encounters between the RCS and the individual Ministries. Represents PSJH from a system perspective when working with payers to challenge and overturn denials of a technical nature. Manages overturn rate data and evaluates trends for improvement opportunities. Routinely communicates trends and other data findings to PFS Manager for consistent and effective feedback to the Ministries and the PSJH Contracting team to assist in developing and implementing processes to maximize collections on denied accounts, as well as improve processes within the ministry to prevent denials from happening. Contributes to the development of all workflows and internal processes of RCS. Works as part of the team to develop meaningful information for Ministries and other stakeholders to improve operational performance and cash collections.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Revenue Cycle Business Services 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:

• 3 years Familiarity with managed care contracting, provider operations and/or payer operations. Experience in negotiations preferred.
• 3 years Patient Accounting experience in a physician office, acute hospital, or medical collections.
• 3 years Billing collections, or denials management experience and medical terminology.
• 3 years Experience in medical management computer applications.

Preferred Qualifications:

• Associate's Degree Or equivalent educ/experience
• 1 year Experience specifically with Epic applications.

Salary Range by location:

NorCal (Napa, Sonoma)

Min: $25.72, Max: $40.13

Southern California, NorCal (Humboldt), Alaska (Kodiak, Seward, Valdez)

Min: $22.93, Max: $35.77

WA Puget Sound, Oregon (Portland), Alaska (Anchorage)

Min: $22.00, Max: $34.31

Oregon (Hood River, Medford, Seaside)

Min: $20.50, Max: $31.99

Eastern Washington (Richland, Spokane, Walla Walla)

Min: $19.57, Max: $30.53

Montana

Min: $17.71, Max: $27.63

Texas

Min: $16.78, Max: $26.17

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.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

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 Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

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: 260620

Company: Providence Jobs

Job Category: Claims

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 4001 SS RC COMMER DENIALS

Address: CA Santa Rosa 1165 Montgomery Dr

Work Location: Santa Rosa Memorial Hospital

Pay Range: $See posting - $See posting

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.