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Providence Health & Services Health Care Services Technician Tier 1 in Beaverton, Oregon

Description:

Providence St. Joseph Health is calling a Health Care Services Technician Tier 1 to our location in Beaverton, OR.

We are seeking a Health Care Services Technician Tier 1 responsible for providing quality service to HCS customers in one or more of the core functional areas including, care management, concurrent review, prior authorization, appeals, claims, provider reconsiderations, medical audit and/or training.

HCS Technicians are responsible for accuracy, integrity, and confidentiality of information received, processed, and subsequent communication of that information to required parties.

MAJOR CHALLENGES

  1. Diffusing potential conflicts while facilitating and negotiating solutions during first contact communications while maintaining excellent customer service, and strong provider network relationships.

  2. Functioning as a liaison and problem solver with multiple providers (physicians, office staff, hospital staff, member, and payer), or Health Plan departments.

  3. Managing multiple priorities and time deadlines efficiently and effectively through ability to work independently while being cognizant of team environment and areas requiring collaboration.

  4. Prioritize and effectively manage multiple tasks and assignments while functioning in a call center queue, authorization queues, claims queues, appeals queues and/or providing multiple job functions during the course of any given day.

  5. Effectively integrating programs and functions across units within Health Care Services.

In this position you will have the following responsibilities:

The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position. The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending upon the nature of the position.

Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization.

For direct patient care roles:

  • Performs and maintains currency of essential competencies as required by specific area of hire and populations served.

  • Triages and documents incoming calls and requests, identifies and obtains resources for those requiring immediate attention and handles these through established protocols utilizing appropriate level of assessment and judgment. Routes work to other resources as deemed appropriate. Monitors, retrieves, and prioritizes incoming work as required.

  • Performs intake and system data entry of information such as authorization and referral requests, patient information, and discharge information.

  • Uses sound judgment in identifying the need for clinical review or nurse/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures. Maintains the accuracy and integrity of the database and all confidential medical record information received and purges medical records as required according to established protocols.

  • Acts as department liaison and resource to members, Health Plan providers, and Health Plan departments to problem solve or address inquiries regarding work, workflow, processes, information system issues and relationships.

  • Educates and assists provider and office staff, members and payers, operations department and other Health Plan employees in Medical Management and Case Management processes and system usage as applicable. Serves as knowledge holder of HCS department duties within the health plan and serves as a consultant as needed and within scope of position.

  • Maintains sound working knowledge of all relevant Providence and department policies and procedures.

  • Understands and is able to effectively use all PHP resources including but not limited to medical policy criteria, prior authorization lists, KMS and established policies and procedures.

  • Maintains a thorough knowledge of utilization management and cost containment strategies, member and providers contracts, utilization management and case management programs, imaging and workflow systems and personal computer applications.

  • Knowledge in utilization management or care management strongly preferred, such as medical review, claims audit, appeals, delegation, or quality/credentialing.

  • Ability to problem solve.

  • Strong interpersonal skills at all levels from team members to senior level leadership.Good organizational, analytical and problem solving skills along with decision-making capabilities.

  • High degree of accuracy and attention to detail. Work is subject to auditing for accuracy and completion.

  • Must be able to coordinate multiple assignments with tight deadlines requiring time management and prioritization skills.

  • Knowledge of CPT and ICD-10 coding, medical terminology, and general knowledge of the health care environment and delivery systems.

  • Proficient in data entry and word processing. Knowledge in database management and spreadsheets.

  • Knowledge of HIPAA, Fraud, Waste and Abuse Laws.

  • Ability to provide technical direction to coworkers.

  • Ability to be obtain pertinent information necessary to process requests

  • Ability to be trained using established medical policies and department protocols and systems.

  • Ability to utilize judgment to determine which requests/cases require escalation or triage to a nurse, supervisor, manager or medical director.

  • Follows established policies and procedures for all work assigned.

  • Appreciation of cultural diversity and sensitivity toward target populations.

  • Excellent communication skills, ability to communicate in a clear and concise manner, escalating concerns as appropriate depending on urgency.

Qualifications:

Required qualifications for this position include:

• H.S. Diploma or GED

• Experience and a proven track record of learning and applying complex concepts.

• Experience in database management and spreadsheets.

• Experience with telephony systems, call center phone volumes and multi-line communication systems.

Preferred qualifications for this position include:

• Bachelor's Degree in Health related field or equivalent educational/experience.

• Experience in utilization management or care management, such as medical review, claims audit, appeals, delegation, or quality/credentialing.

• Atleast 3 years of experience in health related field.

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

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

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.

About Us

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.

Schedule: Full-time

Shift: Day

Job Category: Patient Services

Location: Oregon-Beaverton

Req ID: 243463

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