Senior Quality Analyst, Claims *Remote*

Description

Providence is one of the nation's leading non-profit healthcare systems with 119,000+ caregivers/employees serving more than 5 million unique patients across 51 hospitals and 800+ clinics. Our locations range from metropolitan centers to rural settings across seven states: Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. As a mission-based, not-for-profit healthcare provider, our commitment to providing compassionate care to all lives on through our five core values: Compassion, Dignity, Justice, Excellence, and Integrity.

Providence caregivers are not simply valued - they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence St Joseph Health operates a self-administered claims program for General and Healthcare Professional Liability, Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims. The Senior Quality Analyst assists the Claims leaders in managing a quality assurance program to ensure compliance with laws and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual learning, data integrity, settlement and excess reporting, payor contracting and other regulatory reporting requirements governing liability claims handling. The candidate selected for this position will be expected to effectively manage multiple priorities at a time, work autonomously in a fast-paced claims environment, and respond positively to change.

The Senior Quality Analyst performs all duties in a manner that promotes Providence's Mission, values, and philosophy. In all aspects, they serve as a role model for the values and Mission of the organization.

Essential Functions:

• Ensure compliance with applicable laws, insurance regulations, settlement reporting, and other regulatory reporting requirements governing liability claims handling
• Develop and provide training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer reporting, applicable laws, insurance regulations, and other regulations relating to investigating, evaluating, and resolving liability claims. Provide empirically-based input as to training topics
• Act as a resource to fellow caregivers for Medicare Secondary Payer reporting of third-party claim payments and write-offs and serve as our mandatory reporting authorized representative
• Facilitate monthly claims files internal audits including monthly trending analysis reporting from platform analytics, compare as to organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending analysis. Review claim files from a quality assurance perspective to ensure compliance with applicable laws, insurance codes, regulations, and our department's policies and procedures
• Secure monthly claims data reports and provide quality assurance recommendations to claims leaders for both indicated opportunity areas relative to organizational metrics and KPIs, compliance, best practices as well as broader application potential of high-performance indicators
• Identify and provide feedback to department leaders for claims management improvement opportunities and claims-related trends through audit, data analytics, and training observations
• Recommend improvement opportunities relating to workflow efficiencies and operationalization to department leaders
• Act as a resource and to fellow caregivers regarding applicable federal, state, and local laws, insurance codes, and regulations relating to liability claims handling, including healthcare professional and general liability matters
• Assist department leaders in developing policies and procedures, as requested
• Manage payor contracting requests for claims histories
• Perform claims-related research
• Ensure appropriate reporting of claims to excess liability insurers

Knowledge required for this position include:

• Healthcare professional liability and/or other civil tort claims handling practices
• Medicare Secondary Payer reporting requirements for third party liability claims
• Reporting to regulatory agencies and state licensing boards
• Insurance Commission requirements within Providence's footprint
• Insurance terminology
• Legal concepts
• Liens
• Electronic claims databases
• Medical terminology

Skills required for this position include:

• Third-party liability claims management skills, including healthcare professional liability and/or other types of civil tort claims
• Exceptional analytical skills
• Communicates respectfully, professionally, concisely, and diplomatically
• Interpersonal skills, including active listening
• Performs challenging tasks with efficacy
• Outstanding organizational skills, including time management, prioritization, and collaboration
• Initiative-taking
• Adaptability
• Self-management skills
• Digital literacy, including navigating within an electronic claims environment

Abilities required for this position include:

• Exercises critical thinking and creative problem-solving when performing job duties
• Act as a resource to fellow caregivers for MSP, regulatory, and state licensing reporting
• Ability to train fellow caregivers
• Effectively articulate ideas and information
• Open to constructive feedback
• Collaborate with others
• Demonstrate teamwork
• Ability to work autonomously in fast-paced work environment
• Demonstrate positivity in response to change

Required Qualifications:

• Bachelor's Degree in Business Administration, Public Health Administration, Organizational Leadership, Finance, or a related discipline -OR- a combination of equivalent education and work experience

Preferred Qualifications:

• Coursework/Training: Liability claims training within the insurance industry
• 5 or more years of experience handling healthcare professional liability and/or other types of civil tort claims within the insurance industry or similarly structured self-insured organization
• 5 or more years of experience reporting third party liability settlements to Centers for Medicare and Medicaid Services (CMS), and federal and state licensing and/or regulatory agencies, including the National Practitioner's Database (NPDB)
• Experience reviewing claims files for quality assurance purposes
• Experience working with claims data analytics
• Experience in project management
• Experience creating and facilitating claims management training
• Experience developing policies and procedures

Salary Range by Location:

• AK: Anchorage: Min: $45.14, Max: $70.07
• AK: Kodiak, Seward, Valdez: Min: $47.05, Max: $73.04
• California: Humboldt: Min: $47.05, Max: $73.04
• California: All Northern California - Except Humboldt: Min: $52.79, Max: $81.94
• California: Southern California: Min: $47.05, Max: $73.04
• Montana: Except Great Falls: Min: $36.34, Max: $56.41
• Montana: Great Falls: Min: $34.43, Max: $53.44
• Oregon: Non-Portland Service Area: Min: $42.08, Max: $65.32
• Oregon: Portland Service Area: Min: $45.14, Max: $70.07
• Texas: Min: $34.43, Max: $53.44
• Washington: Western - Except Tukwila: Min: $47.05, Max: $73.04
• Washington: Southwest - Olympia, Centralia: Min: $45.14, Max: $70.07
• Washington: Southwest - Clark County: Min: $45.14, Max: $70.07
• Washington: Eastern: Min: $40.16, Max: $62.35
• Washington: Southeastern: Min: $42.08, Max: $65.32

Why Join Providence?

• Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 357280

Company: Providence Jobs

Job Category: Clinical Quality

Job Function: Quality/Process Improvements

Job Schedule: Full time

Job Shift: Day

Career Track: Business Professional

Department: 4008 SS RIS

Address: WA Renton 1801 Lind Ave SW

Work Location: Providence Valley Office Park-Renton

Workplace Type: Remote

Pay Range: $47.05 - $73.04

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.