Manager of Provider Services
PacificSource

Salem, Oregon

Posted in Utilities


This job has expired.

Job Info


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.

Position Overview: Supervise and provide guidance to Provider Service Team Lead(s) and team members regarding company policies, procedures, standards and workflow. Ensure strategic initiatives are met with common practices throughout the PacificSource service areas. 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.

Essential Responsibilities:

  • Take a leadership role in the development, implementation, and ongoing operation and maintenance of provider service core job duties.
  • Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes.
  • Facilitate Service team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing operations.
  • Provide supervision, coaching, training, support, evaluation, and leadership to team lead(s) and assigned staff.
  • Coordinate with Provider Service staff in all offices to ensure common practices, streamlined processes and efficient, excellent customer service.
  • Establish and track metrics to measure Service staff performance and set goals and targets.
  • Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards to monitor key performance indicators and identify improvement opportunities.
  • Establish training plans and documentation for the Provider Service team.
  • Act as a liaison for PacificSource between provider groups, members, and PacificSource to resolve escalated issues.
  • Educate and inform on PacificSource administrative and claims procedures, healthcare and the health insurance industry, and claims coding issues.
  • Supervise and facilitate development of the Provider Manuals, newsletters, websites and other provider communicative tools.
  • Supervise and facilitate development of workshop materials, identifying common practices and educational opportunities across states.
  • Represent the needs and concerns of the Provider Network department in management and other committee meetings. Relay pertinent information related to work on the committees that affect the Provider Network department.
  • Investigate and resolve issues escalated by Provider Service team lead(s) and staff. Relay information for dispute resolution to appropriate departments and personnel.
  • Coordinate business activities by maintaining collaborative partnerships with key departments.
  • Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees.
  • Actively participate as a key team member in department meetings.
  • Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.


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.


Work Experience: 5 years' experience in provider service or other related healthcare role, and previous experience managing teams in a healthcare or other related field required.

Education, Certificates, Licenses: Bachelor's Degree in related field or equivalent combination of education and experience and CPC certification are required.

Knowledge: Effective written and oral communication. Ability to read, understand and communicate policies. Ability to read, understand, and communicate provider contractual agreements. Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Effective problem solving skills required. Requires ability to define and prioritize problems and manage workload without direct supervision. Ability to use judgment to make logical decisions that are consistent with company culture and philosophy. Medical terminology proficiency. General computer, word processing and spreadsheet skills.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.

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.

Our Values
  • 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.


This job has expired.

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