Providence Health Plan is calling a Health Care Services Technician Tier 1 to our location in Beaverton, OR. . This position has the option of in office or has the option of a hybrid model with combination of in office (2-3 days a week) and remote. We are seeking candidates that are available in commute distance to the office in Beaverton, OR.
We are seeking a Health Care Services Technician Tier 1 who will be 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.
A technician can advance through three defined levels of this job category. There are six major areas of activity: 1) Training and Experience, 2) Technical Skills, 3) Communication and Interpersonal Skills, 4) Team Involvement and Interaction, 5) Business Knowledge, and 6) Management of Time and Time Off.
In this position you will have the following responsibilities:
Independently coordinates and processes medical prior authorizations, concurrent authorizations, claims, or provider appeals taking into consideration medical benefits, medical policies, documented technician approval criteria, and information submitted by provider.
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.
Authorizes payment of medical claims and DMRs (direct member reimbursements) according to established departmental policies and within job scope.
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.
Required qualifications for this position include:
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 applicable work experience may be substituted for some education.
Experience in utilization management or care management, such as medical review, claims audit, appeals, delegation, or quality/credentialing.
3 years experience in health related field.
Knowledge in utilization management or care management strongly preferred, such as medical review, claims audit, appeals, delegation, or quality/credentialing.
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: Patient Services
Other Location(s): Oregon
Req ID: 348810