PacificSource Health Plans jobs - 51 jobs

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Vendor Procurement Generalist provides essential support to the Vendor Procurement Manager and team by coordinating vendor intake, contract tracking, and associated activities. This role plays a key part in maintaining accurate records, monitoring contract timelines, and fostering cross-departmental collaboration to ensure efficient operations and adherence to procurement policies throughout the contracting process. Essential Responsibilities: Support the Enterprise Vendor Management office in coordinating vendor intake, contract routing, tracking, and supporting processes. Assist internal stakeholders with vendor onboarding activities, including gathering required documentation and reviewing for relevance & quality of business owner inputs. Assist in obtaining finance related documents including W9s and Direct Deposit forms. Research and organize historical executed agreements relevant for the Legal review process, when needed. Track contract status and timelines, ensuring timely follow-up for renewals, amendments, and expirations. Help keep contract repository up to date, ensuring accurate cataloging of executed agreements. Monitor and report on contract routing progress, flagging delays, or missing information. Provide administrative support for procurement activities. Provide general support for department initiatives including assisting with system transition activities related to the future implementation of formal vendor management software. 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 or additional projects assigned. SUCCESS PROFILE Work Experience: Minimum of 2 years of experience in procurement, vendor management, or related field, including experience with contract management. Education, Certificates, Licenses: High school diploma or equivalent required. Associate's degree or relevant coursework in business or supply chain preferred. Knowledge: Ability to communicate clearly and professionally, both in writing and verbally, with internal stakeholders and external vendors. Strong organizational skills and attention to detail in managing documentation, timelines, and contract-related tasks. Ability to prioritize multiple assignments and follow through independently. Familiarity with procurement processes, vendor onboarding, and basic contract terminology. Demonstrates accountability for the accuracy and completeness of procurement-related documentation. Maintains a collaborative mindset and supports cross-functional coordination. Upholds high ethical standards and professionalism in all interactions. Competencies Adaptability Attention to Detail Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $39,807.95 - $63,692.71Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

Title: Office Support Clerk, Sr. Department: Contribution Accounting Union: UFCW 555 Grade: 2 Provides exceptional customer service to members and providers regarding routine to moderately complex billing and eligibility issues. Creates and maintains accurate enrollment, billing and eligibility records for administration of Plan benefits; reconciles and troubleshoots moderately complex issues. Position works within plan guidelines and applicable regulations such as Taft Hartley, ERISA, HIPAA, etc. Accomplishes work independently with minimal supervision. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provide customer service (telephone, electronic and in-person) for billing and eligibility to providers, members and employers; maintain positive client relationships. Prepare and process incoming/outgoing contribution reports; review for completeness and accuracy; correct discrepancies. Prepare termination letters, COBRA and self-pay correspondence, and HIPAA notices. Process COBRA payments, refund requests, disability waivers and cash receipts. Process new enrollments and update existing enrollments for participants and qualified dependents. Identify, request and follow up on necessary dependent documentation (i.e. marriage licenses, birth records, domestic partner information, etc.). Provide eligibility updates to outside insurance carriers. Update participant and dependent information in the system; perform other general data entry and clerical tasks. Receive and process new employer contracts. Consistently meet established performance standards. Occasional work outside of normal work hours (i.e. weekends/extended hours) based on business needs. Perform special projects as requested by management. Perform other related duties and special projects as assigned. Minimum Qualifications Possess a strong work ethic and the ability to work effectively in a team environment; Highly developed sense of integrity and commitment to customer satisfaction; High school diploma or general education degree (GED); Minimum 1 year of related experience; Ability to type 45 WPM and use a 10-key; proficient PC skills, including MS Word and Excel; Strong math skills including the ability to calculate figures and amounts such as discounts, interest, proportions, and percentages; Solid organization skills with strong detail orientation/high degree of accuracy; Strong research, analytical and problem-solving skills; Ability to communicate clearly and professionally, both verbally and in writing; Ability to effectively present information in one-on-one situations to customers, clients and other employees; Ability to follow standard operating procedures; Able to maintain excellent attendance and punctuality; Read and interpret documents and write routine reports and correspondence. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Title: Client Relationship Assistant FLSA: Non-exempt Hours per week: 40 The Client Relationship Assistant position comprises a range of administrative responsibilities, including fund administration, board meeting administration, and data collection. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Support the Client-facing team in performing administrative tasks. Creates correspondence, reports, presentations, and meeting notes for internal use or distribution to clients or vendors; performs filing, editing, copying, or collating as needed. Keeps records in relation to the disbursement process. Coordinates meetings, activities, and other events as assigned, including scheduling, catering, and meeting room preparation. Assists the Client-facing team with analysis and internal reports to support day-to-day activities; manages internal audit data collection, including financial, DOL, and Operational Controls Audits. Manages administrative responsibilities, including invoice preparation and approval, payable handling, filings, and applications. Performs other related duties as assigned. Minimum Qualifications Highly developed sense of professionalism, maturity and integrity. Experience working in a collaborative team environment. Ability to successfully communicate and execute with all levels of the organization in a heavily matrixed environment. Ability to work in a fast-paced environment managing multiple projects and incoming requests. Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities. Strong organizational skills with an attention to detail. Strong time management skills, capable of prioritizing workload effectively to meet deadlines. Excellent verbal and written communication skills. Proficiency in MS Office tools and applications. Preferred Qualifications Experience in an administrative role in communications, marketing, or client management. Experience working in a healthcare environment or third-party administrator. Knowledge of Taft Hartley organizations. Experience working in Client Services, Client Management, or Customer Service. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements. May be required to work remotely. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Senior Risk Adjustment (RA) Analyst assists in the accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services (CMS) for all risk adjustable populations. This position leverages available tools and knowledge of the applicable risk models to optimize data submission as it pertains to Hierarchical Condition Categories (HCCs), HEDIS and Quality performance as well as other data within a given system. The Senior RA Analyst will collaborate and coordinate with internal and external partners to minimize submission and response errors, provide thorough oversight of vendor partners, accumulate, and report out on pertinent data sets, develop and improve processes related to risk adjustment and quality improvement, maintain required documentation, and ensure compliance to all applicable laws, guidance, and regulations. Assume lead role on specified projects. Projects are completed with cross-functional teams of peers and business partners. This includes interaction with provider partners with the intent of informing them on performance and educating on best practices in risk adjustment. The Senior RA Analyst will provide mentorship to less experienced team members. In addition, this position influences decision making by leadership and provides recommendations regarding potential improvements to risk adjustment processes and outcomes. Essential Responsibilities: Recommend and guide process improvements that will optimize risk adjustment factor increases while minimizing inaccurate capture of disease burden. Identify, analyze, interpret and communicate risk adjustment trends to be consumed by provider partners and related entities. Responsible for maintenance of existing reports, development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed. Develop and maintain reporting capabilities to measure and forecast risk scores & quality metrics, monitor suspecting model performance, and identify areas of improvement Maximize risk adjustment revenue and quality bonus payments by driving data integration and analytics to properly capture and improve the health status of PacificSource members. Validate data integrity and collaborate with technical teams to improve data pipelines and business logic for identified areas of opportunity Identify and lead internal subject matter experts in regular meetings to identify and rectify various data submission and adjudication errors related to risk adjustment and quality data submission. Develop and maintain data sets leveraging internal data, response data from regulatory entities (including but not limited to: EDGE files, MMR, MOR, RAPS Response, MAO-004, PSV, PLD, etc.), and ancillary data sources to be consumed across the enterprise. Demonstrate mastery in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, and others as needed. Maintain strict oversight of vendor partners through analytic reconciliations to ensure regulatory compliance, optimal data submission and error resolution, and general accuracy. Assist with all pertinent audits, including RADV, through preparation activities and documentation. Perform root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps. Maintain a high level of familiarity of current CMS regulations and announcements affecting risk adjustment and CMS Star Ratings. This includes review of regulatory announcements, attending educational sessions and opportunities provided by regulatory entities or within the industry. Develop, maintain, and report out on actionable metrics related to risk adjustment and HEDIS to incorporate quality/health outcome metrics where applicable. Prepare new and review existing specifications, project plans, and other internal procedural documents. Ensure users and partners understand nature of work being performed, as well as timeframes and milestones. Provide regular status updates to supervisors and stakeholders. Provide support as needed for projecting annual receivable amounts, preparing projections related to pricing efforts, and predicting cost utilization as it relates to risk adjustment. Work with changing data, file specifications, and internally coordinate releases and modifications through approved procedures. Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes. Work with internal teams, provider partners, and vendor partners as needed to support risk adjustment activities. Provide mentorship, leadership, and training to less experienced risk adjustment analysts. 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. Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Five years' experience in data analytics or software development required, to include at least three years' experience in Health Plan required. In depth risk adjustment and/or HEDIS experience required, including risk models, CMS guidelines, regulatory data submissions, retrospective and prospective programs, interpreting health care regulatory/accreditation requirements and data validation audits. Expertise in Microsoft Excel and SAS/SQL is required. Experience in leading projects and project teams required. Familiarity with Medicaid risk adjustment and CMS 5-Star required. Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred. Equivalent work and education experience will be considered. Education, Certificates, Licenses: Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required. Advanced degrees preferred. Knowledge: Expert-level analytical and problem-solving abilities are required. Mastery of theories and applications of computer programming required. Ability to keep current with changing technologies, work independently under limited supervision, exercise initiative within established procedural guidelines, and prioritize work to meet established deadlines a must. Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner. The ability to establish and maintain effective work relationships, exercise good judgement, and demonstrate decisiveness and creativity. Read, understand, and interpret documents of complex subject matter. Competencies: Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time with some overnight travel. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $74,601.93 - $126,822.77Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Clinical Pharmacist is responsible for participation in all day-to-day aspects of the Pharmacy Services Department, including but not limited to issuance of all pharmacy coverage decisions, development of policies and procedures and coordination of pharmacy benefits for members. Responsible for participation in the Pharmacy & Therapeutics (P&T) Committee including reviewing and presenting new drug reviews, drug class reviews, and policy reviews. Responsible for maintaining compliance with all state and federal legislation. Serve as a clinical resource person for Health Services staff, other internal associates, and external vendors as necessary. Essential Responsibilities: Provide drug coverage determinations for members with PacificSource Health Plans. Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email. Support clinical meetings with internal and external stake holders as requested. Review prescription formularies and criteria for needed updates based on clinical guidelines. Participate in P&T Committee meetings through review of new drugs, drug classes, and authorization policies with presentation of materials to staff members prior to meetings and to committee members during meetings. Lead and / or assist in projects as assigned. Stay up to date on State and Federal regulations as they relate to health insurance coverage. Stay up to date on quality measures pertinent to Pharmacy Services. Keep current with new and emerging clinical trends. Supporting Responsibilities: Act as backup for other team members and departmental functions. Work with Clinical Pharmacy Manager and/or designee to improve processes, systems, reporting, and services provided by the department Represent Pharmacy Services Department, both internally and externally, as requested. 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. SUCCESS PROFILE Work Experience: Three or more years of pharmacy related work-experience is preferred. Additional experience managing complex work processes and working as part of a multidisciplinary care team is highly preferred. Prior success in healthcare integration, process development and program implementation is desirable. Education, Certificates, Licenses: Required to be a registered pharmacist with either Pharm D degree or Bachelor of Science in Pharmacy. Additional certifications may be needed such state specific credentials. Certification support may be available for credentials needed post-hire. Post-graduate training (examples include Residency, Fellowship, MBA, BCPS) is preferred. Knowledge: Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Knowledge and comprehension of pharmaceutical services, including federal and state statutes and regulations as they pertain to the insurance-related pharmacy services and benefits administration. Ability to assess pharmaceutical alternatives, treatment plans, drug technologies and new approaches to delivering pharmacy services. Strong verbal and written communication skills. Proficiency in Microsoft Office Suite. Ability to work independently and within groups with minimal supervision. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Provider Network Maintenance Associate is responsible for maintaining the accuracy and integrity of provider data within the organization's systems. This role involves updating provider records, ensuring compliance with all regulatory requirements, and supporting Provider Network Operations by managing data related to provider contracts, reimbursements, and credentialing. The Associate will work closely with various teams, including Provider Relations, Provider Reimbursement Analytics, Provider Network Credentialing and Compliance, to ensure that provider information is up-to-date and accurate, which is critical for smooth operations and timely reimbursements. Essential Responsibilities: Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers, meeting department service level expectations. Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure accurate contract rows are added for correct claims payments. Perform regular audits of provider data to ensure accuracy, compliance with internal standards, regulatory requirements, and support ongoing maintenance and data integrity of provider information. Assist in the management of provider directories, ensuring they are current, accurate, and meet the needs of members. Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools, ensuring provider data meets all regulatory and accreditation standards, including state and federal requirements. Support the monitoring and maintenance of provider records for compliance with organizational policies, procedures, and contracting regulations. Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues, and research and respond to detailed provider inquiry issues routed from customer/provider service departments. Communicate with providers to obtain necessary documentation or clarify discrepancies in data, ensuring positive and effective working relationships. Provide support and assistance to other team members as needed to ensure the overall effectiveness of the provider network operations. Identify opportunities for process improvements related to provider data management, maintenance, and contribute to quality assurance initiatives to continuously improve data accuracy and process efficiency. Assist in the development and implementation of best practices for provider data entry and maintenance, and participate in projects related to provider network expansion, system upgrades, or regulatory changes. Maintain positive and effective working relationships with team members and other departments. Supporting Responsibilities: Meet department and company performance and attendance expectations, maintaining a high level of data accuracy and productivity. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned, contributing to the overall success of the Provider Network Department. SUCCESS PROFILE Work Experience: A minimum of 2 years of experience in an office environment is required, preferred experience in healthcare data management, network operations or data analysis. Preferred familiarity with provider network operations included, but not limited to, provider credentialing, healthcare regulatory requirements, contracting or reimbursement processes. Education, Certificates, Licenses: High School Diploma or equivalent required, Associate's or Bachelor's degree preferred. Knowledge: Fast and accurate data entry skills. Self-motivated. Able to learn and be trained on new systems, databases, and applications Effective written and oral communication. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-10 coding preferred. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel may be required 5% of the time for training and/or external meetings. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $35,542.81 - $56,868.50Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

The Contribution Accounting Processor provides account reconciliation and resolves customer inquiries for assigned Trusts ensuring compliance with associated plans and company guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Handles customer inquiries via telephone, electronic modes, and in-person for billing questions to stakeholders such as employers, providers, auditors, or client representatives. Processes COBRA payments, self-pay payments, refund requests, and cash receipts. Receives and processes new employer contracts. Maintains and updates existing contracts. Prepares and processes incoming and outgoing contribution reports; reconciles reports to payments. Researches discrepancies, credits, retro-payments and problems; contacts employers regarding discrepancies. Submits deposits, requests stop payments, and reconciles batch files making corrections when needed. Performs delinquency and payroll audit processing to include reporting, follow-up, and preparation for entry into computer system. Reviews, researches, corrects, and balances month end edit reports. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of related work experience such as third-party administrator processing, bookkeeping, finance, banking, or accounting. Proficiency with MS Office tools and applications. Computer literate with ability to learn new applications and systems. Preferred Qualifications Experience working in a healthcare environment or a third-party benefits administrator. Bilingual English/Spanish verbal and written communication skills. Proficiency with 10 key calculations. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. May be required to work remotely based on business needs. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

The Client Relationship Manager supports the Director, Client Relationship across their book of business (BOB) in fund management, with direct client and vendor liaison as required by the Director, Client Relationship. The Client Relationship Manager works alongside the Director, Client Relationship to learn the role, with a gradual increase in responsibility as appropriate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Monitors government filings and current government regulations that may affect the operations of the Company or the client. Facilitates client meetings, including minute-taking and recording key actions from board meetings. Manages contracts and documentation including client financial statements, Summary Plan Descriptions, benefit communications, and other documents at the direction of client and fund counsel. Collation of monthly financial reports from the Finance Team and appropriate due diligence of outputs. Supports the Director, Client Relationship in managing all aspects of the client relationship and account-related activities with assigned client(s). Understands and remains current on account strategy and specific needs of the assigned client(s), and is responsible for maintaining the compliance calendar for each assigned client. Conducts board meeting pre-alignment including collation of Administrative Reports for board meetings. Provides account management support by conducting research needed for issue resolution. Acts as the secondary liaison between the Boards of Trustees, and Professionals of the Benefit Funds with Zenith Operations Staff. Supports the Director, Client Relationship in the facilitation of participant engagement, for example, via external retirement seminars. Supports the Director, Client Relationship in all aspects of the vendor relationship, including analysis and reporting for vendors and third parties. Maintains communications and effective working relationships. Prepares and edits correspondence, presentations, and reports, including complex Excel files, meeting notes, and other documents for internal use or distribution to clients or vendors. Responds to requests from clients, government agencies, unions, participants, attorneys, consultants, and auditors; acts as liaison between internal departments and clients. Coordinates invoices and expense reports with the accounting department for clients or vendors and ensures timely processing. Performs other duties as assigned. Minimum Qualifications Education Associate's degree in a business-related field. Skills Excellent verbal and written communication skills, including interpersonal and presentation skills. Ability to communicate effectively with all levels of an organization. Highly developed sense of professionalism, maturity, integrity, and commitment to customer satisfaction. Exceptional team player with the confidence and integrity to earn the confidence of the client(s) and the internal team quickly. High motivation, ability and willingness to learn. Ability to exercise independent judgment, manage multiple priorities, and consistently deliver high-caliber results. Strong decision-making and organizational skills with the ability to optimize the use of all available resources and deliver on multiple priorities. Proficient PC skills including Microsoft Word, Excel and Outlook skills. PowerPoint experience preferred. Other Ability and willingness to travel as necessary. Preferred Qualifications Bachelor's of Business Administration degree. Experience working in client relationship management. Professional experience working with Taft-Hartley clients and plan professionals. Experience working in a healthcare environment or third-party administrator. Working knowledge of Customer Relationship Management software or systems such as Salesforce or Smartsheet. Knowledge of third-party administrator operations and Taft Hartley organizations. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Regular travel throughout multiple states. May be required to work remotely. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Quality Program Specialist will work directly with internal PacificSource Risk Adjustment team processing all medical record requests in a timely and efficient manner ensuring accuracy and providing the highest quality medical record. The Quality Program Specialist must always safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information follow the request, authorization, PacificSource Health Plans company policy, and HIPAA regulations. Essential Responsibilities: Receives incoming requests for medical records and responds to request in timely and efficient manner ensuring the correct medical record is obtained and valid for risk adjustment review purposes. Validates requests and authorizations for release of medical information according to established procedures and HIPAA guidelines. Performs quality check on all chart retrieval workbooks to verify accuracy of the records before submission to coding. Ability to work with minimum supervision, organize workload and prioritize work tasks to meet production goals. Communicates with Manager on an on-going basis, providing information and data as requested including retrieval feedback needs and requests. Promptly reports to Manager any customer service concerns and/or any potential HIPAA violations whether actual or perceived. Management of member records including file storage that's in alignment with HIPAA laws and regulations and in compliance with Business Associate Agreements. 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. SUCCESS PROFILE Work Experience: 2 years of experience in the health insurance or medical industry required or equivalent education/experience. Experience with Medicare preferred. Education, Certificates, Licenses: High school diploma or equivalent required. Associate degree preferred. Knowledge: General knowledge and understanding of medical terminology, ICD-10-CM, CPT, and health insurance. Ability to review, evaluate and present quality medical records and reports. Good organizational skills with experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, and audio-visual equipment. Knowledge/experience with Medicare quality programs (CMS 5-Star, HEDIS, risk adjustment) preferred. Must have strong analytical and problem-solving skills. Ability to effectively communicate with all levels of staff and management. Must be self-motivated, organized, and detail oriented. Ability to work independently with minimal supervision. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $44,982.98 - $71,972.77Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. Accountable for the effective management of appeals clinical staff. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. May be called upon to perform routine day-to-day program functions. Actively participate in program development and implementation. Supervise and provide guidance to direct reports and other department staff regarding company policies, procedures, and operations. Manage the quality and productivity of team tasks and workflow as they relate to both assigned functions and the overall effectiveness of the Health Services team. Work to resolve issues and improve processes and outcomes. Essential Responsibilities: Take a leadership role in the development, implementation, and ongoing operation and maintenance of assigned programs, services, or functions. Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes. Monitor daily workflow and caseloads and other work processes of team to assure appropriate distribution and processing of tasks. Responsible for the orientation and training of new hires. Provide ongoing supervision, training, evaluation, and leadership to assigned team members. This may include annual reviews, involvement in promotions and/or terminations of employees. Participate in hiring decisions in concert with Appeals and Grievance Director and HR. Monitor and evaluate team assignments relating to volumes, timelines, accuracy, customer service, and other quality and performance measures, and take actions as appropriate. Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize LEAN methodologies for continuous improvement. Monitor key performance indicators and identify improvement opportunities. Serve as liaison with other PacificSource departments or community partners to coordinate optimal provision of service and information. Serve on various internal and external committees as required or designated. Document and report any pertinent communications back to the team or department. Utilize and promote use of evidence-based medical criteria. Maintain modified caseload consistent with assigned responsibilities. Facilitate investigation and resolution of process-related issues as needed. Facilitate conflict resolution, including interfacing with affected departments and individuals, as appropriate. Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal customers. Provide backup to other departmental teams or management staff, as needed. Supporting Responsibilities: Meet department and company performance and attendance expectations. Relate new or revised policies, procedures and/or processes to team members to ensure they have the most up‐to‐date and current information. Facilitate team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem‐solving recommendations, and recommendations of standardizing Health Services operations. Represent the Appeals and Grievance Department, both internally and externally, as requested by Appeals and Grievance Manager and/or Director. Perform other duties as assigned. Work Experience: A minimum of five years clinical experience required. Minimum of three years direct health plan experience in the following areas: utilization management, grievance and appeal, or claims review strongly preferred. Prior supervisory experience preferred. Education, Certificates, Licenses: Registered Nurse/Licensed Social Worker with current appropriate unrestricted state license. Within 6 months of hire licensure may need to include Oregon, Montana, Idaho, Washington and/or other states as needed. Knowledge: Knowledge of health insurance and state mandated benefits. Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes (including ICD-10, HCPC CPT codes). Effective adult education/teaching and/or group leadership skills. Ability to deal effectively with people who have various health issues and concerns. Strong analytical and organizational skills with experience in using information systems and computer applications. Flexible to meet the departments changing needs Ability to develop, review, and evaluate utilization and case management reports. Good computer skills including experience with Word, Excel, and PowerPoint. Ability to use audio-visual equipment. Ability to work independently with minimal supervision. Competencies Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. 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. Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services. Facilitate outstanding member care using fiscally responsible strategies. Essential Responsibilities: Collect and assess member information pertinent to member's history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. Coordinate necessary resources to achieve member outcome goals and objectives. Accurately document case notes and letters of explanation which may become part of legal records. Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs. Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care. Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions. Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets. When applicable, identify and negotiate with appropriate vendors to provide services. When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development. Work with multidisciplinary teams utilizing an integrated team-based approach to best support members, which may include working together on network not available (NNA), out of network exceptions (OONE), and one-time agreements (OTA). Serve as primary resource to member and family members for questions and concerns related to the health plan and in navigating through the health systems issues. Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients. Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines and procedures for Health Services Department. Supporting Responsibilities: Act as backup and be a resource for other Health Services Department staff and functions as needed. Serve on designated committees, teams, and task groups, as directed. Represent the Heath Services Department, both internally and externally, as requested by Medical Director. 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. SUCCESS PROFILE Work Experience: Minimum of three (3) years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required. Experience in acute care, case management, including cases that require rehabilitation, home health, behavioral health and hospice treatment strongly preferred. Insurance industry experience helpful, but not required. Education, Certificates, Licenses: Registered Nurse or a clinically licensed behavioral health practitioner with current unrestricted state license. Within six (6) months of hire licensure may need to include Oregon, Montana, Idaho and/or other states as needed. Case Manager Certification as accredited by CCMC preferred. Knowledge: Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance and state-mandated benefits. Understanding of contractual benefits and options available outside contractual benefits. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of appropriate case management plans. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision. Must be able to function as part of a collaborative, cohesive community. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

The Bookkeeper provides financial accounting for assigned Client(s) and Trust Fund(s) in accordance with company policies, regulatory requirements, and plan guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Balances FICA, federal withholding, and payroll taxes; makes appropriate deposits. Reconciles checking, savings, and investments accounts. Posts journal entries to general ledger. Prepares and distributes Trust financial statements and statistics. Assists in the preparation of 941 and 945 forms. Ensures accounting files are current and in good order. Reviews vendor invoices for accuracy and reasonableness. Makes daily/weekly money transfers as needed. Prepares and sends disbursement letters. May also perform accounts payable function. Performs other duties as assigned. Minimum Qualifications High School diploma or GED. Two years of experience in an accounting role. Knowledge of common accounting principles and practices. Excellent verbal and written communication skills, including interpersonal skills. Ability to read and understand financial statements. Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience in a third-party administrator. Familiarity with accounting software. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Home Infusion Registered Nurse - Accredo Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo by Evernorth has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: Active RN license in the state where you'll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver's license Willingness to travel to patients' homes within a large geographic region Ability to work 32 hours a week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. This position follows established policies and procedures to process a multitude of transactions for Government line of business including but not limited to: demographic updates, notification letters, enrollments, disenrollments, reinstatements, and plan changes. Essential Responsibilities: Process daily returned mail, making any related changes in EAM & Facets contacting the member if needed, and resending documents or processing as required by CMS. Manually create and send Out of Area letters to members who may have moved out of the service area. Research, make changes, and/or complete any Call Tracks regarding enrollment/membership in Facets. Respond to any inquires received via phone calls, e-mails, etc, researching or providing info needed or making any necessary changes to member files as needed for the Government line of business. Add or correct member data in our pharmacy vendor database. Process all Medicare membership enrollment, plan changes, facilitated enrollments and reinstatements. Review the daily EAM Validation report and make corrections as necessary. Process all Medicare membership cancellation of enrollments, cancellation of disenrollment's and death notifications. Process the CMS Enrollment Data Verification monthly audit for address and enrollment updates. Answer Queue Customer Service calls for Medicaid/Medicare members regarding eligibility. Submit miscellaneous transactions to CMS daily as needed. Respond to insurance verification requests for Medicare members. Perform scanning and key wording of ROI's/POA's in to Onbase for the Government line of business. Load ROI/POA documentation in to Facets. Work the monthly P2P report for Accounts Payable Download CMS applications, upload electronic applications in to EAM, save applications and perform indexing of applications in onbase. Process all Medicare COB. Send COB letters to members, update Facets and the COB database and submit member information backs to ECRS. Supporting Responsibilities: Follow company and department policies. Meet department and company performance and attendance expectations. Provide backup support for other members of the enrollment team. Ability to judge severity of problems and the need to escalate to peers and/or management. Support and participate in continuous improvement initiatives. Maintain professional, service oriented relationships. 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: Minimum 2 years of administrative experience with at least 1 year in health insurance billing or related healthcare experience required. Demonstrated ability to work efficiently and effectively with a high attention to detail. Education, Certificates, Licenses: High School Diploma or equivalent required. Knowledge: Ability to understand and interpret Federal and Oregon State laws and contract provisions. Proficiency in Microsoft Applications. Demonstrated organizational and time management skills. Requires keyboarding and 10-key skills. Experience with problem solving and ability to read system reports. Competencies: Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel expected less than 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $32,311.65 - $51,698.64Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Associate Project Manager operates in a cross-functional role and has specific expertise in functional areas such as project management, data analytics, business process outsourcing management, business analysis and process improvement management. Acts as a proactive interface between the cross-functional core team, managers, and executive team to ensure effective definition and delivery of the project. Manage entire portfolio of assigned projects, maintaining up to date metrics, and documentation that creates an effective level of transparency and accurately reflects the current state of each project. Interact with all departments and personnel, as needed, including external customers, vendors and consultants. Essential Responsibilities: Manage assigned Operational projects according to life cycle (define, plan, execute, control). Develop and manage project schedule; timelines, activities, milestones. Assess/analyze resource constraints/capacity and plan accordingly. Ensure/oversee complete requirements gathering and documentation. Create weekly status reports for each project and report status to the necessary stakeholders. Conduct regular/weekly team meetings on all projects. Monitor project risks and issues and maintain log files. Monitor and maintain scope and/or solicit sponsor approval. Coordinate with the business and participate in QA test iterations. Solicit team member collaboration on issues and problems. Identify appropriate project priorities and effectively communicate to team members. Maintain central point of contact with external vendor(s). Utilize Lean/process improvement methodology to achieve strategic goals. Presents projects and collaborates with various stakeholders. 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. Customer service oriented, and commitment to establishing and maintaining positive and healthy working relationships. Ensure compliance with standards, policies, procedures, requirements, and regulations. Pilot new hardware and/or software and determine capabilities and/or limitations. Perform other duties as assigned SUCCESS PROFILE Work Experience: Minimum 2 years required in a business analyst/project management or equivalent role leading teams in a complex business and systems environment with a preference towards Insurance. Education, Certificates, Licenses: BA/BS in Business, or related field or equivalent work experience. Project Management Certification Preferred. Knowledge: Understanding of health insurance as it relates in Medicare, Medicaid and Commercial lines of business as well as payment methodologies (fee for services, capitation, and blended). Good understanding of project management principles and practices. Possess knowledge and ability to tailor project management approach as necessary to fit the specific needs of a given project. Ability to communicate effectively across all levels of the business. Demonstrated ability to project manage multiple, parallel projects and staff requirements. Excellent computer skills, including experience with project management tools such as Microsoft Project. Advanced experience with Microsoft Office Suite. Ability to work independently with minimal supervision. Excellent math skills required, including percentages, ratios, graphing, and spreadsheet skills. Must have exceptional written and verbal communication skills. Highly organized, detail oriented, and flexible. Excellent observation skills with proven ability to think critically and analyze complex systems. Adept at evaluating problems accurately and displaying sound judgment, including measured risks and timely escalation. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $56,779.86 - $96,525.75Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Clinical Pharmacist is responsible for participation in all day-to-day aspects of the Pharmacy Services Department, including but not limited to issuance of all pharmacy coverage decisions, development of policies and procedures and coordination of pharmacy benefits for members. Responsible for participation in the Pharmacy & Therapeutics (P&T) Committee including reviewing and presenting new drug reviews, drug class reviews, and policy reviews. Responsible for maintaining compliance with all state and federal legislation. Serve as a clinical resource person for Health Services staff, other internal associates, and external vendors as necessary. Essential Responsibilities: Provide drug coverage determinations for members with PacificSource Health Plans. Provide effective communication for members, providers, and internal staff through various platforms such as clinical calls, coverage determination letters, and email. Support clinical meetings with internal and external stake holders as requested. Review prescription formularies and criteria for needed updates based on clinical guidelines. Participate in P&T Committee meetings through review of new drugs, drug classes, and authorization policies with presentation of materials to staff members prior to meetings and to committee members during meetings. Lead and / or assist in projects as assigned. Stay up to date on State and Federal regulations as they relate to health insurance coverage. Stay up to date on quality measures pertinent to Pharmacy Services. Keep current with new and emerging clinical trends. Supporting Responsibilities: Act as backup for other team members and departmental functions. Work with Clinical Pharmacy Manager and/or designee to improve processes, systems, reporting, and services provided by the department Represent Pharmacy Services Department, both internally and externally, as requested. 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. SUCCESS PROFILE Work Experience: Three or more years of pharmacy related work-experience is preferred. Additional experience managing complex work processes and working as part of a multidisciplinary care team is highly preferred. Prior success in healthcare integration, process development and program implementation is desirable. Education, Certificates, Licenses: Required to be a registered pharmacist with either Pharm D degree or Bachelor of Science in Pharmacy. Additional certifications may be needed such state specific credentials. Certification support may be available for credentials needed post-hire. Post-graduate training (examples include Residency, Fellowship, MBA, BCPS) is preferred. Knowledge: Ability to adapt and prioritize within a fast-paced environment. High attention to detail. Knowledge and comprehension of pharmaceutical services, including federal and state statutes and regulations as they pertain to the insurance-related pharmacy services and benefits administration. Ability to assess pharmaceutical alternatives, treatment plans, drug technologies and new approaches to delivering pharmacy services. Strong verbal and written communication skills. Proficiency in Microsoft Office Suite. Ability to work independently and within groups with minimal supervision. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Provider Network Maintenance Associate is responsible for maintaining the accuracy and integrity of provider data within the organization's systems. This role involves updating provider records, ensuring compliance with all regulatory requirements, and supporting Provider Network Operations by managing data related to provider contracts, reimbursements, and credentialing. The Associate will work closely with various teams, including Provider Relations, Provider Reimbursement Analytics, Provider Network Credentialing and Compliance, to ensure that provider information is up-to-date and accurate, which is critical for smooth operations and timely reimbursements. Essential Responsibilities: Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers, meeting department service level expectations. Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure accurate contract rows are added for correct claims payments. Perform regular audits of provider data to ensure accuracy, compliance with internal standards, regulatory requirements, and support ongoing maintenance and data integrity of provider information. Assist in the management of provider directories, ensuring they are current, accurate, and meet the needs of members. Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools, ensuring provider data meets all regulatory and accreditation standards, including state and federal requirements. Support the monitoring and maintenance of provider records for compliance with organizational policies, procedures, and contracting regulations. Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues, and research and respond to detailed provider inquiry issues routed from customer/provider service departments. Communicate with providers to obtain necessary documentation or clarify discrepancies in data, ensuring positive and effective working relationships. Provide support and assistance to other team members as needed to ensure the overall effectiveness of the provider network operations. Identify opportunities for process improvements related to provider data management, maintenance, and contribute to quality assurance initiatives to continuously improve data accuracy and process efficiency. Assist in the development and implementation of best practices for provider data entry and maintenance, and participate in projects related to provider network expansion, system upgrades, or regulatory changes. Maintain positive and effective working relationships with team members and other departments. Supporting Responsibilities: Meet department and company performance and attendance expectations, maintaining a high level of data accuracy and productivity. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned, contributing to the overall success of the Provider Network Department. SUCCESS PROFILE Work Experience: A minimum of 2 years of experience in an office environment is required, preferred experience in healthcare data management, network operations or data analysis. Preferred familiarity with provider network operations included, but not limited to, provider credentialing, healthcare regulatory requirements, contracting or reimbursement processes. Education, Certificates, Licenses: High School Diploma or equivalent required, Associate's or Bachelor's degree preferred. Knowledge: Fast and accurate data entry skills. Self-motivated. Able to learn and be trained on new systems, databases, and applications Effective written and oral communication. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-10 coding preferred. Competencies: Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel may be required 5% of the time for training and/or external meetings. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $35,542.81 - $56,868.50Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.

Senior Director, Product & Regulatory Management page is loaded## Senior Director, Product & Regulatory Managementlocations: Portland, ORtime type: Full timeposted on: Posted Todayjob requisition id: 2025-1770*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, sex, sexual orientation, gender identity, national origin, genetic information or age.** PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.The Senior Director, Product and Regulatory Management is responsible for leading teams in three key domains: 1) the development, implementation, and management of the end-to-end product lifecycle for Medicare and commercial lines of business; 2) efficient and effective commercial business administration; and 3) compliant and effective regulatory communications. Working with company leadership, the Senior Director is responsible for developing and implementing products that achieve membership and profitability targets. In support of strategic business plans developed by the leaders responsible for profit and loss of the lines of business, this position ensures the product lifecycles, annual roadmaps, filings, and communications meet business needs. The Senior Director ensures the organization complies with product, filing, and communication-related processes and timelines, as well as manages major milestones, risk and mitigation planning, tracking and reporting, and communication across the organization. The Senior Director leads product strategy, development, the annual bid process, and corresponding initiatives. The product portfolio includes Medicare Advantage, Dual Special Needs Plan (DSNP), fully insured group business, and Individual offerings, on and off exchange, as well as corresponding regulated filings and materials. The communications portfolio supports regulated communications, predominantly for Medicare Advantage, DSNP, and Medicaid plans. The Senior Director manages a leadership team to deliver on this critical work.**Essential Responsibilities:*** Lead the product portfolio development and execution strategy across segments and multiple plan years. Direct the Medicare and Commercial product strategy and portfolio management to ensure profitable growth consistent with business plans. Oversee each step of the work from development to assessment and implementation. Lead, coordinate, and communicate product and lifecycle activities with others in the organization. Oversee successful and timely annual bids, filings, related regulatory submissions, and go-to-market activities.* Oversee development and deployment of regulatory communication materials and processes, including Annual Notice of Change, directories, Evidence of Coverage, handbooks, formulary materials, forms, letters, and other regulated materials.* Oversee the preparation of all filings and compliant regulatory documents across the product portfolio, including health contracts, self-funded materials, and related documents.* Oversee implementation of state and federal benefit mandates, including benefit changes and member communication requirements.* Provide strategic advice for PacificSource teams to ensure plan information is accurate and available timely within required timeframes. Ensure proactive communication of new and revised plan designs and benefits to internal stakeholders.* Develop and improve processes, driving administrative efficiencies and cost savings, including leading in a matrixed environment and emphasizing execution, market positioning, and operational tactics. Drive operational excellence, sustainability, and profitable growth.* Generate local competitive market insights to drive innovation and decision making. Conduct market research, competitive analysis, and financial assessments to evaluate improvement opportunities and business strategies in concert with PacificSource's enterprise strategy. Implement strategies across segments and markets.* Develop structures and processes to ensure compliance, including leading cross-functional teams. Collaborate with Marketing, Sales, Operations, Health Services, and Compliance. Develop strategic business partnerships with internal departments and leaders to ensure strong operating performance, high member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance.* Work closely with Compliance and others to ensure policies, procedures, workflows, lifecycle strategies, product offerings, and success initiatives comply with state and federal regulations. Participate in compliance audits, activities, and planning.* Negotiate business relationships with vendors and oversee the execution, implementation, and oversight of the contracts.* Develop and monitor departmental budgets and take corrective action as necessary.* Provide leadership and mentoring to the enterprise product team, the business administration team, and the regulatory communications team. Foster leadership development and advancement. Develop succession plans. Manage, coach, motivate, and guide employees.* Support the organization's commitment to diversity, equity, inclusion, and belonging by fostering a culture of dignity, cultural awareness, compassion, and respect.**Supporting Responsibilities:*** Meet department and company performance and attendance expectations.* Follow the PacificSource privacy policy HIPAA laws, and regulations concerning confidentiality and security of protected health information.* Perform other duties as assigned.**SUCCESS PROFILE****Work Experience:** Minimum of eight years of experience in product, portfolio, lifecycle management, and regulated communications, or substantially equivalent work in highly regulated functions. Exemplary work history with a proven record of success in positions of progressively greater responsibility managing people and achieving business goals and objectives. A solid grasp of the managed care field and insurance regulations is crucial for this role. Experience with strategic planning, communications, sales, product development, regulatory filings, and managing teams required. Leadership experience in a managed care organization requiring advanced knowledge of products, regulatory filings, and regulated communications. Experience with end-to-end product development and lifecycle management of Medicare Advantage, Individual, and group segments, on and off exchange. Experience providing oversight to ensure the successful regulatory filing of all required product materials. Demonstrated success working in a matrixed environment with the ability to set a path and inspire others to follow. Proven record of accomplishment as a driver of process improvement and identifier of efficiency opportunities and ability to lead change. Experience with federal and state regulatory compliance for health insurance plans. Proven ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing abilities; and ability to handle multiple priorities and deal with ambiguity.**Education, Certificates, Licenses:** Bachelor's degree required with a focus in health care administration, business, public policy, public health, or a related field. Master's degree or other advanced degree preferred.**Knowledge:** Advanced knowledge of Medicare Advantage, DSNP, fully insured group business, and Individual, on and off exchange, along #J-18808-Ljbffr

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Senior Risk Adjustment (RA) Analyst assists in the accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services (CMS) for all risk adjustable populations. This position leverages available tools and knowledge of the applicable risk models to optimize data submission as it pertains to Hierarchical Condition Categories (HCCs), HEDIS and Quality performance as well as other data within a given system. The Senior RA Analyst will collaborate and coordinate with internal and external partners to minimize submission and response errors, provide thorough oversight of vendor partners, accumulate, and report out on pertinent data sets, develop and improve processes related to risk adjustment and quality improvement, maintain required documentation, and ensure compliance to all applicable laws, guidance, and regulations. Assume lead role on specified projects. Projects are completed with cross-functional teams of peers and business partners. This includes interaction with provider partners with the intent of informing them on performance and educating on best practices in risk adjustment. The Senior RA Analyst will provide mentorship to less experienced team members. In addition, this position influences decision making by leadership and provides recommendations regarding potential improvements to risk adjustment processes and outcomes. Essential Responsibilities: Recommend and guide process improvements that will optimize risk adjustment factor increases while minimizing inaccurate capture of disease burden. Identify, analyze, interpret and communicate risk adjustment trends to be consumed by provider partners and related entities. Responsible for maintenance of existing reports, development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed. Develop and maintain reporting capabilities to measure and forecast risk scores & quality metrics, monitor suspecting model performance, and identify areas of improvement Maximize risk adjustment revenue and quality bonus payments by driving data integration and analytics to properly capture and improve the health status of PacificSource members. Validate data integrity and collaborate with technical teams to improve data pipelines and business logic for identified areas of opportunity Identify and lead internal subject matter experts in regular meetings to identify and rectify various data submission and adjudication errors related to risk adjustment and quality data submission. Develop and maintain data sets leveraging internal data, response data from regulatory entities (including but not limited to: EDGE files, MMR, MOR, RAPS Response, MAO-004, PSV, PLD, etc.), and ancillary data sources to be consumed across the enterprise. Demonstrate mastery in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, and others as needed. Maintain strict oversight of vendor partners through analytic reconciliations to ensure regulatory compliance, optimal data submission and error resolution, and general accuracy. Assist with all pertinent audits, including RADV, through preparation activities and documentation. Perform root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps. Maintain a high level of familiarity of current CMS regulations and announcements affecting risk adjustment and CMS Star Ratings. This includes review of regulatory announcements, attending educational sessions and opportunities provided by regulatory entities or within the industry. Develop, maintain, and report out on actionable metrics related to risk adjustment and HEDIS to incorporate quality/health outcome metrics where applicable. Prepare new and review existing specifications, project plans, and other internal procedural documents. Ensure users and partners understand nature of work being performed, as well as timeframes and milestones. Provide regular status updates to supervisors and stakeholders. Provide support as needed for projecting annual receivable amounts, preparing projections related to pricing efforts, and predicting cost utilization as it relates to risk adjustment. Work with changing data, file specifications, and internally coordinate releases and modifications through approved procedures. Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes. Work with internal teams, provider partners, and vendor partners as needed to support risk adjustment activities. Provide mentorship, leadership, and training to less experienced risk adjustment analysts. 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. Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Five years' experience in data analytics or software development required, to include at least three years' experience in Health Plan required. In depth risk adjustment and/or HEDIS experience required, including risk models, CMS guidelines, regulatory data submissions, retrospective and prospective programs, interpreting health care regulatory/accreditation requirements and data validation audits. Expertise in Microsoft Excel and SAS/SQL is required. Experience in leading projects and project teams required. Familiarity with Medicaid risk adjustment and CMS 5-Star required. Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred. Equivalent work and education experience will be considered. Education, Certificates, Licenses: Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required. Advanced degrees preferred. Knowledge: Expert-level analytical and problem-solving abilities are required. Mastery of theories and applications of computer programming required. Ability to keep current with changing technologies, work independently under limited supervision, exercise initiative within established procedural guidelines, and prioritize work to meet established deadlines a must. Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner. The ability to establish and maintain effective work relationships, exercise good judgement, and demonstrate decisiveness and creativity. Read, understand, and interpret documents of complex subject matter. Competencies: Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time with some overnight travel. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $74,601.93 - $126,822.77Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: 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.