Encounter Data and Reconciliation Coordinators

Do you have experience providing data synthesis, analysis and reporting within the context of healthcare claims processing? Do you enjoy conducting root cause analyses and summarizing insights to facilitate collaboration and decision-making? We look forward to hearing from you!

Work Location: Salem/Marion; hybrid position

What you will do!

Coordinated Care Organizations (CCO) Reconciliation Coordinator. The primary purpose of this position is to ensure the reconciliation between the Monthly Enrollment File (834) sent by the Oregon Health Authority (OHA) Medicaid Division and CCOs is completed monthly.  This position analyzes discrepancies, systematic or otherwise between Medicaid and the contractors.  This position analyzes enrollment into the CCOs and proposes potential procedures for completing those reviews thoroughly, making recommendations for enrolling, disenrolling, and possibly recouping capitation. Capitation is the payment that is made monthly to the CCOs so they will provide services to Oregon Health Plan (OHP) members. When enrollment issues are found, this position will do deep analysis in multiple systems to identify the cause and potential necessary solutions.

Encounter Data Coordinator/Senior Claims Analyst. The primary purpose of this position is to ensure that Encounter Data and Fee-For-Service claims are processed according to related Code of Federal Regulations (CFRs), Oregon Administrative Rules (OARs), and contractual requirements.

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

What's in it for you?

• We offer exceptional medical, vision and dental benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs. Try this free virtual benefits counselor by clicking here: https://www.oregon.gov/oha/pebb/pages/alex.aspx  
• Paid Leave Days:
  • 11 paid holidays each year
  • 3 additional paid "Personal Business Days" each year
  • 8 hours of paid sick leave accumulated every month
  • Progressive vacation leave accrual with increases every 5 years
• Pension and retirement programs 
• Optional benefits include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
• Click here to learn more about State of Oregon benefits. 

WHAT WE ARE LOOKING FOR:

Minimum Qualifications

Any combination of experience and education equivalent to three years professional-level evaluative, analytical and planning work.

Example: 

A Bachelor's Degree or higher in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills will substitute for all work experience. An Associate’s will substitute for 18 months of experience.

Desired Attributes

• Evidence of ongoing development of personal cultural awareness and humility, and knowledge of social determinants of health and their impacts on health outcomes.
• Experience factoring in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.
• Knowledge of Oregon Administrative Rules and Oregon Revised Statutes, other applicable regulations, and program requirements.
• Knowledge of health services delivery systems, particularly the Oregon Health Plan/ Medicaid administration in Oregon and relational landscape of key partners, providers, community based organizations, and advocacy groups.
• Knowledge of Medicaid Management Information System (MMIS) functionality.
• Experience within the context of healthcare claims processing, including medical and dental billing and coding practices.
• Ability to explain and offer expert level technical assistance on rules, policy, and procedures. 
  • Constructive and Collaborative Working Relationships 
  • Customer Service and Person-centered Engagement
  • Issue Identification and Resolution
  • Research and Root Cause Analysis
  • Data Synthesis, Analysis and Reporting
  • Performance / Process / Quality Improvement
  • Expert level Technical Assistance
  • Written and oral communication, including preparation of reports
• Experience developing and providing planning tools, documents, data, and meeting coordination to facilitate collaboration and decision-making.
• Ability to demonstrate advanced Microsoft Excel, Word, Outlook, and use of collaboration tools such as Microsoft Teams and SharePoint. 
• Demonstrates skills in the following areas: 

How to apply:

Complete the online application at oregonjobs.org using job number REQ-160445

 Application Deadline: 07/12/2024

Salary Range: 4138 - 6322