Claims Analyst II - 90141

US-OR-Hillsboro
Department
Tuality Health Alliance-90109
Req #
2018-4375
Job Type
Full Time (80 hours per pay period)
Shift
Days
# of Openings
1
Classification
Non-Exempt
Budgeted Hours Per Pay Period
80

Summary of Duties

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.

Hiring Competencies

  1. Associate Degree preferred or minimum of 2-4 years working in Oregon Health Plan Claim environment preferred.
  2. Knowledge of claims payment administrative guidelines and policies.
  3. Experience paying medical claims and an ability to “troubleshoot” claims payment problems.
  4. Working knowledge of medical terminology, ICD-9 / ICD-10 and CPT codes.
  5. Experience with medical coding and hospital coding standards that meets THA requirements including common practices for most commercial payers.
  6. Experience working in highly confidential settings.
  7. Strong interpersonal and communication skills, both verbal and written and ability to function effectively in a team environment.
  8. Proven ability to engage in discussion and team environment.
  9. Sound decision making abilities.
  10. Intermediate math skills
  11. Possess excellent telephone skills and interpersonal abilities, both verbal and written.
  12. Ability to write and develop policies and procedures.
  13. Ability to prioritize workload with minimal supervision.
  14. Willingness to work overtime which may include weekends due to various deadlines and claim volume
  15. Presents a good first and lasting impression by personal appearance and interpersonal skills.

Overview

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!

Additional Posting Information

Tuality Healthcare believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.

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