Work in Washington Veterans Jobs

Working Each Day to Make a Difference

At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.

* *

*Claims Investigation Analyst I *

[POSITION PURPOSE:]{.underline}

Responsible for the review and resolution of complex claims issues, using established state and federal guidelines, departmental policies, and procedures ensuring that the work is performed accurately and delivered to meet set objectives. Act as the liaison between the BPO and Community Health Plan of Washington business units for the resolution of claims issues. Responsible for follow up with providers, internal and external vendors to ensure resolution is communicated to impacted parties.* *

[PRINCIPAL DUTIES:]{.underline}

• Receive phone calls, emails, and faxes from providers and respond appropriately as well as assess appeals and determine appropriate action.
• Act as the technical claim's expert, following state and federal guidelines, and Community Health Plan of Washington provider contracts.
• Accurately evaluate, analyze, and resolve complex claims and provider billing issues in a timely manner and according to set standards.
• Collaborates and coordinates with BPO Operations to ensure accurate interpretation of billing guidelines, contract benefits, exclusions, and limitations, and escalate as necessary.
• Assist in optimizing workflows, troubleshooting and problem solving to insure corporate goals are met.
• Respond accurately and courteously to provider inquiries or internal parties regarding benefit interpretation, eligibility, claims status, accessing care through plan providers, and other related issues.
• Commitment to a philosophy that supports single contact resolution.
• Identify and initiate claims processing adjustments as needed.
• Utilize all resources both internal and external and apply that knowledge to improve efficiency and accurately respond to inquiries.
• Meet quality standards.

[QUALIFICATIONS:]{.underline}

[Education]{.underline} & [Prior Related Experience]{.underline}:

•  Have a minimum of 2 years' experience in a healthcare/insurance setting or provider billing setting resolving complex claims required.
• Have Medicaid and Medicare experience required.
• Have experience with HCA and CMS billing guidelines.
• Have a high school diploma or GED preferred, but not required.

[Employment Eligibility:]{.underline}

Candidate has not been sanctioned or excluded from participation in fe