Providence Supervisor Service Operations in Beaverton, Oregon
Providence St. Joseph Health is calling a Supervisor Service Operations to our location in Beaverton, OR.
We are seeking a Supervisor Service Operations who will be responsible for the daily management of claims and encounter processing for one or more of the Health Plan's Commercial, ASO, Individual or Public Programs products and services. It is also responsible for the management and coordination of large reprocessing projects coming from internal and external sources. Direct reports include exempt and non-exempt staff. Coordination with quality improvement initiatives, regulatory requirements, and ongoing day-to-day production needs are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectation of member, providers, employer groups, regulatory requirements regarding accurate and timely claims processing and auditors. Works with vendors,consultants and other PHP staff in performing their duties. Coordinates day-to-day production, project work, and quality improvement activities. Performs a key leadership role in providing a supportive, team-based environment.
In this position you will have the following responsibilities:
Supervises a Service Operations Claims Team responsible for one or more areas including claims processing, claims reprocessing, encounter data, and incoming customer inquiries from members and providers.
Achieve organization's performance standards for claims processing and member/provider inquiries.
Supervises coordination of all work, quality improvement activities, projects, objectives, and staffing of the department by working with direct manager.
Provides a supportive, team-based environment that facilitates group decision making and employee empowerment.
Evaluates performance and initiates personnel actions such as hiring, merit increases, probationary and periodic reviews, promotions, transfers between teams, and disciplinary actions.
Collaborate with the Claims Teams and Claims Support Team to develop training curriculums for staff to stay current, to increase knowledge, and to become cross-functionally proficient.
Fosters professional relationships with peers in Operations, Finance, Sales, Communications, Information Services, Regulatory, Underwriting, Provider Relations, Health Care Services and Pharmacy.
Collaborates on audit activities performed by outside entities including OID, CMS, DMAP and other entities.
Coordinate and support claims and referrals testing activities for system upgrades, fixes and conversions and yearly benefit changes.
Coordinate and prioritize large claims reprocessing projects.
Support the Claims Technical Specialists for on-the-job training and for developing curriculum for staff to stay current, to increase knowledge and to become cross-functionally proficient, by providing group and individual instruction and clear and current claims, referral and encounter documentation.
Support the Claims Managers and Claims Director in the coordination of work specific to quality improvement initiatives, pend management and benefit and project implementations.
Coordinating, loading and conducting annual benefits testing and training, including processes for creating test scenarios and expectations for outcomes and reporting outcomes.
Provide mentoring that supports the development plans for Technical Specialists and Service Specialists to improve skills for future advancement.
Documentation review and oversight as needed. Modeling and encouraging caregivers to update documentation for clarity.
Required qualifications for this position include:
Bachelor's Degree in Business Management, Healthcare Administration, Accounting, or related field, plus 4 years management/industry experience -OR- Associate's Degree with 6 years related management/industry experience or 8 years related management/industry experience.
2 years health Plan Operations and/or Claims Leadership Experience.
2 years experience in project management.
2 years experience using on-line interfaces including PHP Intranet and the Internet.
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: Non-Clinical Lead/Supervisor/Manager
Req ID: 296700