Medical Claims Processor III

Northwest Physicians Network - Tacoma, WA

Full-timeEstimated: $47,000 - $65,000 a year

Northwest Physicians Network is now offering qualified candidates an opportunity to join our team as a Claims Processor III. Our company values innovative problem solvers, promotes personal and professional growth and provides a supportive working environment that affords all its employees a healthy work/life balance.

The Claims Processor is responsible for analyzing and adjudicating routine and complex medical claims while maintaining production and quality standards. Medical claims processing experience is a must. We are looking for someone with a strong attention to detail, excellent analytical thinking skills and who is adept at incorporating company procedure.

Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By supporting clinical integration and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients.

Status: Regular, Full-time, FLSA Non-exempt

Primary responsibilities will include:

  • Enters CMS 1500 information in the Professional Claims module of the EZ-CAP system
  • Enters UB-04 facility information into the Hospital Claims module of the EZ-CAP system
  • Independently process routine and complex medical claims, with back-up customer service responsibility
  • Performs all functions required to complete batch of claims, includes verification of eligibility, referrals and authorizations
  • Refers to Claims Operations Director with questions regarding complex claims issues or covered benefits
  • Skillful in developing a process for task tracking and trending purposes
  • Document claims information if necessary, as specified in Claims Policies and Procedures
  • Keeps current on individual plan benefits for which claims are being adjudicated
  • Brings to the attention of the responsible party regarding any plan benefits which do not appear to be adjudicating correctly on the EZ-Cap system
  • Daily management of pended claims report
  • Assist other processors with claims as needed to minimize backlog
  • Conducts or supports training efforts
  • Audits claim reports to ensure accurate, thorough and timely adjudication of claims
  • Documents plan information not currently available in EZ-Cap and forwards to appropriate staff
  • Pends claims that require additional research or special consideration
  • Documents telephone inquiries in the claim note
  • Proactively identifies claims processing improvement opportunities
  • Daily work assigned with an associated accuracy of 95%

Minimum Requirements:

  • HS Diploma or equivalent, AA degree preferred
  • 4 years’ experience processing medical claims
  • Demonstrated knowledge of hospital/physician medical and billing terminology, Medicare, Medicaid Guidelines, RVS, CPT, HCPCS, RBRVS, DRG, ICD-10, Redbook, CMS 1500, UB-04, and per diem payments schemes
  • Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
  • Strong verbal, written communication skills and customer service skills gained through previous work experience
  • EZ-CAP, Excel, MS Office 365 and SharePoint experience a plus

What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Type: Full-time


  • relevant: 3 years (Preferred)

Work Location:

  • One location


  • Health insurance
  • Dental insurance
  • Vision insurance
  • Retirement plan
  • Paid time off
  • Flexible schedule
  • Professional development assistance
  • Tuition reimbursement