Medical Claims Reviewer & Compliance Analyst

Acentra Health; Oregon; Vor Ort; USD 62.000 - 69.000; Vollzeit

Benefits dieser Stelle

Health benefits

Paid time off

Retirement savings

Wellness program

Educational assistance

Zusammenfassung

Acentra Health is seeking a Medical Claims Reviewer to join our growing team in Oregon. This role supports healthcare claims administration, reviews claims and coding compliance, and contributes to policy interpretation and system improvements.

You will analyze billing information, respond to provider inquiries, and help ensure accurate reimbursements while adhering to HIPAA and regulatory guidelines. A Bachelor's degree and 2+ years' experience are preferred.

Qualifikationen

• Bachelor's degree or equivalent combination of experience and education.
• 2+ years of experience in medical claims review, healthcare operations, compliance, medical coding and billing, or related healthcare functions.

Aufgaben

• Review claims, medical records, and supporting documentation to determine coverage and reimbursement.
• Audit claims and records for compliance with coding guidelines, reimbursement requirements, regulations, policies, and program rules.
• Identify and investigate billing irregularities, errors, coding concerns, documentation deficiencies, and potential fraud or abuse.
• Resolve denied claims, billing appeals, provider disputes, reimbursement issues, exception requests, and coverage inquiries.
• Research and respond to questions related to coding, compliance, reimbursement, coverage, billing, and documentation requirements.
• Manage inpatient and outpatient claim reviews and ensure timely reimbursement determinations.
• Interpret regulations, statutes, administrative rules, guidance, and policies related to claims and operational issues.
• Prepare reports, analyses, recommendations, issue summaries, and written interpretations.
• Develop user procedures and documentation related to system and process changes.
• Evaluate legislative and regulatory changes for potential operational impacts.
• Assist with policy development, regulatory implementation, and operational change management.

Kenntnisse

Analytical skills

Communication skills

Problem-solving

Process improvement

Collaboration tools

Ausbildung

Bachelor's degree or equivalent

Jobbeschreibung

Acentra Health is seeking a Medical Claims Reviewer to join our growing team in Oregon. This role supports healthcare claims administration, reviews claims and coding compliance, and contributes to policy interpretation and system improvements.

You will analyze billing information, respond to provider inquiries, and help ensure accurate reimbursements while adhering to HIPAA and regulatory guidelines. A Bachelor's degree and 2+ years' experience are preferred.