Providence Health & Services Quality Medical Management Tech in Beaverton, Oregon
Providence St. Joseph Health is calling a Quality Medical Management Tech to our location in Beaverton, OR.
In this position you will have the following responsibilities:
Proficient in the principle duties or functions of one or more core Utilization Management Program or Quality Medical Management Department functional areas.
Performs duties or functions of a core program (as assigned) according to established guidelines and analyze and prepare summary of results as requested. Work with Manager/Director to develop corrective action plans as needed to improve outcomes.
Acts as a resource and provides technical assistance to the nursing staff and medical directors on member contracts, claims payment procedures, coding systems, claims research, database management and department operating procedures.
Researches 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.
Enters data and manages databases as required for management and support of programs and core functions.
Trains or re-trains staff as necessary based on expertise, experience, action plans, external changes, or demands (regulatory or product).
Required qualifications for this position include:
High school diploma or equivalent work experience (five years in related field).
Three years’ experience in health insurance.
Good organizational, analytical and problem solving skills along with decision-making capabilities.
Familiar with project management methodology and experience as lead or team member on a project team.
Must be able to coordinate multiple assignments with tight deadlines requiring outstanding time management and prioritization skills.
Knowledge of CPT and ICD-9 coding, medical terminology, and general knowledge of the health care environment and delivery systems.
Proficient in data entry and word processing. Knowledge and experience in database management and spreadsheets.
Knowledge of QMM operations processes.
Demonstrated training and coaching skills.
Preferred qualifications for this position include:
Knowledge and/or experience in a utilization management functional area such as case management, concurrent review, prior authorization, medical audit, appeals or delegation.
Two years additional experience in a business environment.
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 a full comprehensive range of benefits - see our website for details
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 Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. 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)
Req ID: 228530