Job Overview
Responsible for maintaining and updating the GE/Centricity/IDX Managed Care Application (MCA) module for US Family Health Plan's managed care line of business. Builds fee schedules, provider and vendor dictionary entries, and plan benefits and exclusions. Assists with health plan utilization management reporting for the organization. Ensures optimal payment methodology from US Family Health Plan to vendors and other providers. Responsible for all reports and data transfers to the Department of Defense and its contractors. Provides support for the quality management program.
Responsibilities
- Maintain and update the GE/Centricity/IDX MCA module for US Family Health Plan.
- Build fee schedules, provider and vendor dictionary entries, plan benefits and exclusions.
- Assist with health plan utilization management reporting.
- Ensure optimal payment methodology for payments from US Family Health Plan to vendors and other providers.
- Produce all reports and data transfers to the Department of Defense and its contractors.
- Support the quality management program.
Required Qualifications
- Bachelor’s Degree in a related field or equivalent experience in Health Care Business Administration as required by URAC.
- Minimum of four years’ experience in managed care operations or large group practice setting.
- Microsoft SQL Server experience.
- Knowledge and experience coding with CPT, ICD-9, and ICD-10.
- Understanding of financial/administration/clinical business functions and the interfaces/relationships between applications in healthcare.
Preferred Qualifications
- Experience with Access and reporting from a warehouse type database.
- Experience with HEDIS reporting.
- Experience with GE/Centricity/IDX healthcare software application.
- Clinic setting operations experience highly desirable as complementary experience to the above.
Benefits
Our best‑in‑class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We provide a comprehensive benefits package including a retirement 401(k) plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, paid parental leave, vacations, holidays, health‑issues time off, voluntary benefits, well‑being resources, and more.
About Providence
At Providence, our strength lies in the 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 foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Our 120,000 caregivers serve in over 50 hospitals, 1,000 clinics, and a full range of health and social services across eight states.
About The Team
Pacific Medical Centers (PacMed) is a private, not‑for‑profit, primary and integrated multi‑specialty health care network with outpatient clinics and primary and specialty providers in King, Snohomish, and Pierce counties. We combine patient‑centered care with cutting‑edge technology, first‑class facilities, and board‑certified providers.
Equal Employment Opportunity Commitment
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 or military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by law.
Job Details
- Requisition ID:
- Company: Pacific Medical Jobs
- Job Category: General Operations
- Job Function: Operations
- Job Schedule: Full time
- Job Shift: Day
- Career Track: Business Professional
- Department: 3060 WA USFHP
- Workplace Type: Hybrid
- Pay Range: $38.01 – $60.00 per hour
- Location: Seattle, WA (Hybrid)
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.
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