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Provider Service Team Lead

Company: PacificSource
Location: Tacoma
Posted on: August 7, 2022

Job Description:

Looking for a way to make an impact and help people?

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.

Nature or Scope:

Supervise and provide guidance to Provider Service team members including Specialists, Representatives, and other Provider Service staff regarding company policies, procedures, and workflow. Set goals and implement strategies to ensure team members are effectively assisting providers with internal processes, while representing the company to providers externally. Resolve provider concerns referred by assigned staff and other people within the company. Monitor, evaluate, and report service standards. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team support, manage change and encourage innovation, build both internal and external collaborative relationships, encourage involvement and initiative, and develop in others' increased vision and commitment to goals. Observe assigned staff when educating provider offices on current coding and PacificSource administrative policies and claims procedures.

Essential Functions:

* Provide supervision, coaching, training, support, evaluation, and leadership to assigned staff.
* Coordinate with staff to resolve potential problems with provider groups and work to ensure satisfaction with PacificSource.
* Assist staff with a variety of quality, attribution/assignment and claims reports as well as other information pertaining to the provider's practice.
* Create, evaluate, and track metrics to measure Service staff performance.
* 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, members, and PacificSource to resolve problems and comply with requests.
* Communicate with provider offices and their staffs and PacificSource internal departments.
* Document problems, issues, and resolution in provider files or Facets call log as needed.
* Supervise the development and maintenance of the Provider Manuals, websites and newsletters.
* Communicate via email and website postings to applicable provider partners as necessary.
* Supervise and assist with provider education via introductory meetings, webinars and presentations, including information on the PacificSource mission and values, InTouch functionality and registration, claims procedures, administrative procedures, member plan information, provider networks, and how to access information and assistance through designated staff.
* Serve on various interoffice committees as required or needed.
* Represent the needs and concerns of the Provider Network department.
* Document and report back to Provider Network any pertinent information related to work on the committees that would affect the Provider Network department. Investigate and settle issues not resolvable by Provider Service staff.
* Relay information for dispute resolution to appropriate departments and personnel.
* Oversee staff participation in local medical organizations such as Medical Assistants Organization and local chapters of the American Academy of Professional Coders (AAPC).
* Complete other projects and duties as needed and assigned.

Relationships: Work closely with Provider Network Department, the provider community, professional organizations (such as OSMA, AAPC), vendors, and all PacificSource staff.

Qualification Requirements:

Work Experience: 1-3 years experience as a Provider Service Specialist or Representative within PacificSource and/or with 5 years experience in healthcare field. Supervision experience preferred, but not required.

Language 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.

Mathematical Skills: Basic math skills required, including percentages, ratios, graphing and spreadsheet skills.

Reasoning Ability: Ability to read, understand and communicate PacificSource policy. Effective problem solving skills. Ability to read, understand, and communicate provider contractual agreements. Requires ability to define and prioritize problems and manage workload without direct supervision. Use judgment to make logical decisions that are consistent with company culture and philosophy.

Education, Certificates, Licenses, Registration: High school diploma or equivalent. CPC or CPC-P certification is preferred but not required.

Other Skills and Abilities: Medical terminology proficiency. Experience or education in ICD-10-CM and CPT 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. Ability to prioritize work. Current Oregon driver's license. Travel throughout the state, with some overnight visits required. Generally travel by automobile. Assure that self and staff are consistently helpful, confident, and pleasant with all types of customers, both internal and external. Ability to communicate changes in PacificSource business processes and procedures to internal and external customers both accurately and timely. Ability to lead a team to ensure effective work processes.

Environment: Work inside in a general office setting with ergonomically configured equipment.

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. Communicate clearly and effectively.

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.

Keywords: PacificSource, Tacoma , Provider Service Team Lead, Other , Tacoma, Washington

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