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Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Maintain positive public relations with provider groups and clinic administrators. Act as a personal contact for problem solving, training, materials distribution, and as an information resource.

Communicate via telephone and email throughout the PacificSource service area to educate provider office staff on current coding and PacificSource administrative and claims procedures.

Essential Responsibilities :

• Develop positive working relationships with provider groups and their staff to assure that providers' concerns are addressed by the appropriate person(s) in a timely, responsive manner.
• Provide prompt, professional, and courteous service to providers, members, and PacificSource employees.
• Communicate with providers to resolve potential problems before they become an issue with the provider groups and work to ensure satisfaction with PacificSource.

Distribute a variety of claims analysis reports and other information pertaining to the provider's practice.

• Provide follow-up on behalf of Customer Service and other PacificSource departments regarding participating providers' contract questions or compliance issues.
• Act as a liaison for PacificSource between provider groups, PacificSource members, and PacificSource to resolve problems and comply with requests.

Communicate with provider offices and their staffs, PacificSource departments, PacificSource Special Investigations Unit, and the Provider Contracting team.

Document problems, issues, and resolution in provider files or call tracking as needed.

• Understand and communicate to providers information including PacificSource mission and business, InTouch functionality and registration, claims procedures, administrative procedures, member plan information, provider networks, and how to access appropriate forms and information on the PacificSource websites.
• Assist in the maintenance of provider demographics and serve as a resource to internal personal and provider office staff regarding participating provider maintenance.
• Answer Provider calls and questions from internal and external sources through department's phone queue.
• Assist in the publication and mailing of provider notices.
• Place supply orders and update inventory of PacificSource logo give-away products.

Supporting Responsibilities :

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience : A minimum of 2 year experience at PacificSource in a similar service related role or one year as a Provider Service Specialist 1 or similar work experience within healthcare field.

Education, Certificates, Licenses : High school diploma or equivalent required.

Knowledge : Medical terminology proficiency. Experience or education in ICD-10-CM and coding. General computer, word processing and spreadsheet skills.

Ability to remain current on PacificSource administrative and claims procedures, healthcare and the health insurance industry, and claims coding issues.

Excellent public relations skills. Effective written and oral communication, including diplomacy skills for working with the medical professional community as well as the members enrolled in a PacificSource plan.

Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing.

Competencies : Adaptability

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills :

Accountability, Communication, Communication (written / verbal), Flexibility, Listening (active), Organizational skills / Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.

Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.

Last updated : 2024-06-26