Provider Technical Specialist - Senior in Corvallis, Oregon at Samaritan Health Services
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Job Description
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JOB SUMMARY/PURPOSE
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Serves as a senior technical lead to ensure that provider data is entered and administered properly and in a timely manner. Responsible for staying current on regulations and compliance issues. Leads the advocation of the PDM data entry process as it applies to cross-functional data support. Meets regularly with other Provider Services departments to ensure proper workflow development and policies/procedures are maintained.
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DEPARTMENT DESCRIPTION
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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
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EXPERIENCE/EDUCATION/QUALIFICATIONS
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Associate's degree or equivalent experience required.
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Two (2) years experience in Provider Services required.
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Two (2) years experience in Health Plan Insurance Plans required.
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Previous Facets experience required.
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Previous claims experience preferred.
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KNOWLEDGE/SKILLS/ABILITIES
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Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
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Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
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PHYSICAL DEMANDS
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Rarely
(1 - 10% of the time)Occasionally
(11 - 33% of the time)Frequently
(34 - 66% of the time)Continually
(67 – 100% of the time)CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 – 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK – LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0 - 20 pounds force)
PULL (0 - 20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
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