About the Position:
Oregon Community Programs (OCP) provides behavioral and mental health services to children, youth, and families across a variety of settings, including families of origin, kinship care, foster care, and Treatment Foster Care.
As the Medical Billing and Resolution Specialist, you will play an essential role in managing OCP’s healthcare revenue cycle. You will learn our billing cycle and Electronic Health Records system, work to resolve outstanding claims, and collaborate with clinicians to address claim discrepancies. Our ideal candidate has experience with claim adjudication, payment and recoup postings, and denial management, along with strong attention to detail and problem-solving skills.
This role is a great fit for someone who enjoys the detective work of research, investigation, and problem-solving. We’re looking for someone who is curious, eager to learn, and motivated to identify opportunities for improvement. At OCP, we value connection and offer a supportive, collaborative, and dog-friendly work environment with staff social events. You’ll have the opportunity to work independently and as part of a team while making a meaningful difference in the lives of children and families.
This is a full-time position.
Minimum Job Requirements:
- Associate’s degree in a related or relevant field.
- 3 years’ experience in complex medical billing and root-cause analysis to resolve billed insurance claims.
- Proficient in full Microsoft Office Suite, with an intermediate skill in Excel, and additional emphasis on creating and working with pdfs (will be tested).
- High level of confidence and comfort learning new EHRs, software, and programs.
- Recent knowledge and experience working with Medicaid claims.
- Working knowledge of payor guidelines, medical terminology, CPT/ICD-10 coding, and insurance billing/reimbursement practices.
Our Ideal Candidate:
Experience with:
- Oregon Medicaid and Coordinated Care Organizations, including MMIS
- Behavioral health claims
- CareLogic EHR
- Pivot tables
- Liaison between patients, providers, and insurance companies.
- Commitment to integrity and accountability
Essential Responsibilities:
- Verify client eligibility & benefits using MMIS & other payor portals and manage all follow-through. Audit weekly OHP Eligibility Spreadsheet and make necessary updates in all systems.
- Submit, track and record claims submissions within EHR and Clearinghouse systems.
- Work, resolve and document Clearinghouse rejected claims, payor denied claims, outstanding claims, and EHR failed claims to ensure timely, accurate, and maximum reimbursements. Submit corrected claims, claim reconsiderations/appeals, and/or claim projects.
- Post payments, adjustments, and maintain detailed records in EHR/billing systems with a high level of accuracy. Annotate and process utilizing pivot tables.
- Maintain clear, accurate, and thorough documentation, strong tracking systems, consistent follow-through, and effective oral and written communication.
- Perform other duties as assigned. Includes cross-training to provide vacation/sick coverage for fellow team members.
What We Offer:
- Welcoming team atmosphere, flexibility, and appreciation for having a life outside of work.
- We model and promote communication that fosters connection, respect, and honoring each other’s strengths and differences.
- An opportunity to change the lives of young people and their families.
- Competitive benefits: Comprehensive medical and dental insurance, including prescription, vision, and alternative care coverage (90% employer paid), life insurance, employer retirement contributions to 403(b) plan, and more.
- Paid time off: 33 paid holiday and vacation days/year, separate accrual for sick time.
- Dog friendly office, fun staff social events, people-centered culture.
Benefits and perks:
- 403(b) Plan
- Family Friendly
- Employer Retirement Contributions Match (4% of gross wages vested after 3 years)
- Flexible Spending Plan
- Relaxed Work Environment
- Excellent Admin Support
- Flexible Work Schedule
- Medical, Dental & Vision (90% employer paid)
- Staff Social Events
- Employer Paid Life Insurance
- Employee Assistance Plan (Access to FREE appointments with a mental health counselor, & other supportive benefits)
- Paid Vacation Days (14hrs/month for full time employees)
- Personal & Sick Time (8hrs/month for full time employees)
- Paid Holidays & Office Closures (12 days)
- Dog Friendly Office
- Health Reimbursement Arrangement
Employment Details:
Job Title: Administrative Specialist II, Billing & Resolution Specialist
Reports to: Billing & Compliance Manager
Classification: Salary, Non-Exempt
Job Grade 13: Starting Salary $52,000 to $54,080 range depending on education, experience, and/or other pay differentials. Eligible for performance-based increase up to 3% at 6-month review.
Hours: Typical schedule is Monday through Friday during standard business hours
Anticipated Start Date: as soon as reasonably possible
Location: In person, at 1170 Pearl St. Eugene, OR. Work also takes place in client homes.
DIVERSE CANDIDATES ENCOURAGED TO APPLY
Research shows that women and people of color are less likely to apply for positions if they do not meet 100% of the qualifications. OCP actively encourages submissions from people of color and LGBTQI+ applicants, especially given the prevalence of youth and families in our services from historically marginalized communities. We want to find the best candidate for the job, and that person may be one who comes with relevant transferable skills from a variety of sources and experiences.
OCP IS AN EQUAL OPPORTUNITY, AFFIRMATIVE ACTION EMPLOYER
We are committed to creating a work environment and culture where our team members grow and thrive. OCP offers flexible work hours, a friendly team atmosphere including staff social events and a dog-friendly office environment. Of course, we are focused on our business, but productivity and flexibility go hand in hand.
We acknowledge that one marker of a healthy organization is strong connections among staff. We strive to maintain an environment where colleagues take time to learn about one another and celebrate diverse ideas and interests. We connect with people in a friendly and outgoing way and respond quickly and supportively to changing situations or conditions. We collaborate as a team and enjoy bouncing ideas off of each other.