CLAIMS PROCESSING ASSISTANT

AllCare Management Services•Grants Pass, OR

1d•Hybrid

About The Position

This position supports claims operations and financial integrity by performing a variety of administrative and department functions related to claims processing, system COB updates, and audit support. Responsibilities include managing Coordination of Benefits (COB) reporting, implementing updates within the EZ-CAP claims system, processing refunds and overpayment recoveries, and assisting with internal and external audit activities, including HSAG, OHA, CMS, and financial audits. The role also involves reviewing claims identified through monitoring reports, ensuring issues are researched and resolved appropriately, and supporting check run activities to help ensure accurate and timely provider payments. This position works collaboratively with all claims staff, finance, compliance, and IT teams to maintain efficient operations and ensure adherence to regulatory and organizational requirements.

Requirements

High school diploma or general education degree (GED) required. College degree in an applicable field is preferred.
One to two years related experience and/or training in administrative and/or medical claims processing required.
Knowledge of and compliance with HIPAA regulations.
Proficient in data entry and use of claims management systems
Knowledge of Medicare and Medicaid, procedures, and regulatory requirements
Basic understanding of medical coding and billing practices
Strong attention to detail and ability to identify discrepancies or inconsistencies
Excellent organizational skills and ability to manage multiple tasks efficiently
Excellent communication skills, both written and verbal, for interaction with internal and external stakeholders
Exceptional writing, editing, and proofreading skills.
Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Skilled at breaking a project into definable and measurable tasks and tracking progress to completion.
Excellent customer service skills to respond appropriately and interact positively with upset customers.
Reliable, confident, and effective in fostering positive relationships.
Demonstrates accountability, inspires trust, and connects well with colleagues.
Trustworthy, accountable, and skilled at collaborative engagement.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to work with problems involving a few concrete variables in standardized situations.

Nice To Haves

EZ-CAP claim processing system experience is highly preferred.
Certified Professional Coder (CPC)
Certified Clinical Medical Assistant (CCMA)
Certified Billing and Coding Specialist (CBCS)
Certified Medical Administrative Assistant (CMAA)
Certified Coding Specialist (CCS)

Responsibilities

Maintain and update Coordination of Benefits (COB) information, including reporting, verification, and system updates to ensure accurate claims processing
Review, research, and process refund requests and overpayment recoveries, ensuring compliance with contractual, regulatory, and internal policies
Provide departmental support for internal and external audits, including preparation of documentation and data requests for entities such as HSAG, CMS, and financial auditors