This position is responsible for adjudicating and reviewing medical and/or dental claims and performing general claim processing production. This position is also responsible for coordinating claims activities including data entry and claim auditing by performing the following duties.
- Processes claims including analyzing claims for appropriateness of services and the interpretation of benefits in accordance with established contracts.
- Maintains a thorough working knowledge of claims processing procedures.
- Appropriately pends claims for eligibility, referral, coordination of benefits, provider enrollment or medical review.
- Assists management in the development and maintenance of the claims processing function.
- Reviews atypical claims with management for assistance and guidance.
- Assists in the claims auditing process.
- Maintains a thorough working knowledge of Oregon Administrative Rules and the Prioritized list of covered services.
- Assists providers and members with claims customer service calls.
- Maintains confidentiality and complies with HIPAA rules and regulations.
- Maintains punctual, regular, and predictable attendance.
- Works collaboratively in a team environment with a spirit of cooperation.
- Displays excellent communication skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
- Respectfully takes direction from manager.
EDUCATION and/or EXPERIENCE
High school diploma or general education degree (GED) and two to four years related experience and/or training.
COMPUTER SKILLS
Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, word processing, communicate by e-mail and use scheduling software.
We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
- Weekends as needed
Work setting:
Location:
Work Location: Remote