Provide expertise in all aspects of correct processing of Tuality Health Alliance (THA) claims, including knowledge of standard payment methodologies for physician and hospital claims. Performs all aspects of claims processing, cost containment analysis and audits billing practices to ensure alignment with State and Federal coding guidelines and monitoring for fraud and abuse. Responsible for claims compliance program requirements including but not limited to; encounter data, sterilization audits, accurate payment review programs, and financial reporting. Works collaboratively with staff and vendors to perform testing on claims payment systems to ensure accurate and timely processing. Acts as liaison to contracted claims processing staff for training, questions, and issues. Communicates with THA physicians, clinic staff and hospital of correct coding and submission of claims. Serves as liaison to Customer Service, Medical Management and Provider Relations. Works cohesively with Customer Service to resolve claims processing issues and/or concerns. Participates in shared decision making teams and cross trains within the Claims Department to meet any department needs.
At Tuality Healthcare, an OHSU Partner, it's an honor and a privilege to serve those near us. That's why since our beginnings in 1918, and as we expand our strong network of services through our clinical affiliation with OHSU, we continue to be committed to providing the best health care possible and a valued community partner. Our affiliation with OHSU brings the advanced medical resources of Oregon’s only academic health center, which allows local providers to receive guidance from some of the country’s top specialists and pass that expertise on to Tuality patients where they can be cared for in their community.
Tuality’s many awards showcase our position as one of the Portland metro area’s premier healthcare providers, including 5th straight year in Top 10 Healthiest Employers in Oregon from The Portland Business Journal, Tuality’s 6th straight Gold Plus Award from the American Heart Association, and 2016 #1 Nationwide Best Hospital IT Department to work for according to Healthcare IT News.
Here at Tuality our employees care about making a difference. In fact, they care so much that in our most recent employee satisfaction survey we had an 80% participation rate! Tuality is truly unique because of the relationships we build and as individuals we are seen and heard. Come be part of our team, and let your voice be heard!