PacificSource Health Plans

PacificSource Job Openings


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Search Results

Job Locations US-OR-Bend
Position Overview: Process Medicaid professional claims in a workflow role environment. Accurately interpret benefit and payment provisions applicable to Medicaid enrollees. Review and resolve claim edits using multiple systems, processes and procedures. Maintain production and quality standards. 
Type
Regular Full-Time
Job Locations US-OR-Eugene
Assist in the credentialing/recredentialing process for practitioners and facilities for network participation. Ensure all credentialing/recredentialing certification processes and procedures are completed in accordance with established regulatory and policy requirements. Coordinate and review all credentialing/recredentialing applications from new and existing providers; complete follow-up and problem resolutions as required. Interpret material received for timeliness and contact individual practitioners or department representatives for necessary information. Coordinate the processing, distribution, and management of all credentialing documents for practitioners insuring the information is verified.
Type
Regular Full-Time
Job Locations US-OR-Bend
Provide data analysis for PacificSource to achieve the goals and initiatives identified in our Strategic Plan.  Primary subject of analytic support will be related to analysis of cost and utilization of health services, in support of large employer reporting, financial modeling for provider contracting analysis, and identification of opportunities and evaluation of health services activities, including, but not limited to, disease management, wellness programs, and early identification of high risk populations.  Analytical role may vary and involve knowledge of contract language, healthcare utilization, performance analysis for clinical programs, state and federal guidelines. 
Type
Regular Full-Time
Job Locations US-OR-Portland
The Director of Administrative Services is the primary business segment leader for PacificSource’s growing portfolio of self-funded and Administrative Services.   Working closely with executive leadership for Commercial Programs and Sales, the Director provides strategic leadership enabling PacificSource to achieve its growth, retention, account management, financial and other targets. Key areas of focus will include working with a cross functional team of internal departments, the Director will oversee both the strategic and the day to day administration for Self-funded and Administrative Services. Other key areas of focus include streamlining PacificSource’s self-funded operations, enhancing the competitive differentiation of administrative services capabilities, improving the effectiveness and efficiency of administration while maintaining compliance with applicable state and federal regulation. This position will have a strong partnership with sales and service, toward shared goals of executing self-funded growth initiatives and retention of profitable membership.
Type
Regular Full-Time
Job Locations US-OR-Springfield
The Director of Administrative Services is the primary business segment leader for PacificSource’s growing portfolio of self-funded and Administrative Services.   Working closely with executive leadership for Commercial Programs and Sales, the Director provides strategic leadership enabling PacificSource to achieve its growth, retention, account management, financial and other targets. Key areas of focus will include working with a cross functional team of internal departments, the Director will oversee both the strategic and the day to day administration for Self-funded and Administrative Services. Other key areas of focus include streamlining PacificSource’s self-funded operations, enhancing the competitive differentiation of administrative services capabilities, improving the effectiveness and efficiency of administration while maintaining compliance with applicable state and federal regulation. This position will have a strong partnership with sales and service, toward shared goals of executing self-funded growth initiatives and retention of profitable membership.
Type
Regular Full-Time
Job Locations US-WA-Tacoma
Oversee provider contracting, provider relations, provider partnerships, provider network development, and strategic initiative deployment in assigned territory for PacificSource Health Plans.  Work with senior leadership in Health Services, Finance, Sales and Government Programs to develop key strategies with maximum positive impact.  Deploy resources and oversee key work processes to achieve critical goal attainment across all lines of business including commercial, Medicare and Medicaid.  Work collaboratively with senior leadership in Finance, Operations, AUA, Sales, IT, Health Services, Revenue ,Government Programs, and across teams in Provider Network – as well as external contracted vendors, and external provider partners.
Type
Regular Full-Time
Job Locations US-OR-Bend
Position Overview: Provides support for the day-to-day Print Services and Facilities related functions for our Bend office. Will work cross functionally between Print Services and Facilities in order to assure a high level of internal customer service and productivity in each facet of the department.
Type
Regular Full-Time
Job Locations US-ID-Boise
Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available.  Ensure proper utilization of services and resources. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies.  
Type
Regular Full-Time
Job Locations US-OR-Bend
Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available.  Ensure proper utilization of services and resources. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies.  
Type
Regular Full-Time
Job Locations US-OR-Eugene
Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available.  Ensure proper utilization of services and resources. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies.  
Type
Regular Full-Time
Job Locations US-OR-Bend
Position Overview: Support all aspects of the pharmacy services compliance program for Medicare, Medicaid and Commercial lines of business. Assume the primary role of interfacing with the Compliance department, auditors, vendors and pharmacy staff for purposes of monitoring and ensuring compliant pharmacy operations. Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting the Pharmacy Department. Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance.
Type
Regular Full-Time
Job Locations US-OR-Eugene
Position Overview: Support all aspects of the pharmacy services compliance program for Medicare, Medicaid and Commercial lines of business. Assume the primary role of interfacing with the Compliance department, auditors, vendors and pharmacy staff for purposes of monitoring and ensuring compliant pharmacy operations. Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting the Pharmacy Department. Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance.
Type
Regular Full-Time
Job Locations US-OR-Tigard
Position Overview: Support all aspects of the pharmacy services compliance program for Medicare, Medicaid and Commercial lines of business. Assume the primary role of interfacing with the Compliance department, auditors, vendors and pharmacy staff for purposes of monitoring and ensuring compliant pharmacy operations. Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting the Pharmacy Department. Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance.
Type
Regular Full-Time
Job Locations US-OR-Bend
Position Overview: Coordinate application of pharmacy services and benefits.  Handle pharmacy-related inquiries and communicate benefit determination.  Act as a liaison and information resource to internal and external pharmacy services customers.  Provide pharmacy services Help-Desk support.  Provide pharmacy claims processing services.  Conduct claims audits and prepare prior authorization statistics.
Type
Regular Full-Time
Job Locations US-OR-Eugene
Position Overview: Coordinate application of pharmacy services and benefits.  Handle pharmacy-related inquiries and communicate benefit determination.  Act as a liaison and information resource to internal and external pharmacy services customers.  Provide pharmacy services Help-Desk support.  Provide pharmacy claims processing services.  Conduct claims audits and prepare prior authorization statistics.
Type
Regular Full-Time
Job Locations US-OR-Eugene
Positions in this function are responsible for various activities related to the provider network database for both Commercial and Government lines of business which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement. Maintain all necessary data elements for Groups, Providers and Facilities in our Provider database for all states PacificSource services while compliantly meeting HEDIS and NCQA measurements.  
Type
Regular Full-Time
Job Locations US-OR-Bend
Positions in this function are responsible for various activities related to the provider network database for both Commercial and Government lines of business which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement. Maintain all necessary data elements for Groups, Providers and Facilities in our Provider database for all states PacificSource services while compliantly meeting HEDIS and NCQA measurements.  
Type
Regular Full-Time
Job Locations US-OR-Eugene
Provides a wide range of support to Provider Network, Facets Business Support, Claims, Finance and Analytics in coding, reimbursement methodology research, loading and documentation for all lines of business. Responsible for all regular and off-schedule fee schedule preparation and documentation, including Federal Registers, CMS, DRGs, ASC, ASP, Lab, DMAP, ASA, Essentials RBRVS and PacificSource default fee schedules.
Type
Regular Full-Time
Job Locations US-OR-Bend
Provides a wide range of support to Provider Network, Facets Business Support, Claims, Finance and Analytics in coding, reimbursement methodology research, loading and documentation for all lines of business. Responsible for all regular and off-schedule fee schedule preparation and documentation, including Federal Registers, CMS, DRGs, ASC, ASP, Lab, DMAP, ASA, Essentials RBRVS and PacificSource default fee schedules.
Type
Regular Full-Time
Job Locations US-OR-Tigard
Provides a wide range of support to Provider Network, Facets Business Support, Claims, Finance and Analytics in coding, reimbursement methodology research, loading and documentation for all lines of business. Responsible for all regular and off-schedule fee schedule preparation and documentation, including Federal Registers, CMS, DRGs, ASC, ASP, Lab, DMAP, ASA, Essentials RBRVS and PacificSource default fee schedules.
Type
Regular Full-Time