Claim Processor Jobs in Remote, OR (NOW HIRING)

Description

Job Purpose: 

Functions as a Health Information (HIM)/Compliance Manager (CM) in a team and mission-based setting to provide oversight, management and coordination of electronic and paper medical records, compliance, HIPPA compliance, and risk management. HIM/CM is responsible for ensuring the privacy, safety, and security of medical records. Under direction of the Chief Quality Officer, establishes and maintains departmental policies and procedures to ensure quality and effectiveness of workflow. May spearhead projects dealing with the implementation/enhancement of electronic medical records; identify, compile, and abstract information as requested from electronic system for quality assurance/compliance reporting purposes. Processes and prepares related business and/or governmental forms. HIM/CM has primary responsibility as a front-line resource to respond to requests for records from internal and external sources, compliance, HIPAA, and risk management. This position may be asked to work at other clinic sites as needed.  

Duties: 

• Adhere to the spirit of Waterfall Community Health Center to remove barriers to care and our mission statement while performing assigned duties.  
• Demonstrate the core values of Integrity, Respect, Accountability, Compassion, Partnership and Collaborative Communication.   
• Serve as medical records department subject matter expert; oversee and manage all aspects pertaining to medical records, including but not limited to updated policies and procedures, requests for release of information, death certificates, POLST submissions, digital faxes, and requests for medical records in accordance with state law and HIPPA. 
• Maintains working knowledge of HIPPA rules and regulations and disseminates information as appropriate; applies  to day-to-day operations. 
• Independently reviews and evaluates compliance issues and ensures appropriate departmental collaboration in investigation and resolution, including consultation with General Council to resolve complex legal compliance issues. 
• Identifies potential areas of compliance vulnerability and risk, implements action plans for resolution, provides guidance on how to avoid similar situations in the future.  
• Performs Compliance and Risk Management investigations, providing recommended course of action to mitigate  risk; provides regular compliance and risk management reports to Executive Leadership and the Board. 
• Ensure integrity of project data by auditing results and providing to applicable managers for appropriate action. 
• Participate and/or facilitate internal committees as directed, including the QA Committee, QI Committee and Health and Safety Committee. 
• Provides required documentation to support FTCA redeeming application submission. 
• Facilitates WCHC Privileging process; refers to Board adopted policy. 
• Acts as point of contact for patient complaints and grievances, including FTCA complaints. 
• Preservation of all heath center documentation related to any actual or potential claim or complaint (for example, medical records and associated laboratory and x-ray results, billing records, employment records of all involved clinical providers, and clinic operating procedures. 
• Reporting claims and potentially compensable events (PCEs) to the appropriate entity, including medical malpractice insurance providers or U.S. Department of Health and Human Services Federal Tort Claims Act (FTCA) claims (as appropriate) and other insurers in accordance with the requirements of the insurance policy/contract and FTCA 
• Performs other duties as needed to help drive our Vision, fulfill our Mission, and abide by our Organization's Value

Requirements

Education and/or Experience and Qualifications: 

• High School Diploma or GED equivalent required and/or associate degree in health information management. 
• 10-15 years healthcare experience preferred 
• Demonstrates required customer service and phone etiquette competencies 
• Experience with electronic medical/health records (EHR/EMR) required, with experience in OCHIN Epic preferred 
• Experience managing the lifecycle of electronic and paper medical records, health care industry preferred 
• Maintain confidentially - in accordance with WCHC policies and HIPAA regulations 

Licensures/Certifications Requirement: 

• RHIT and/or CHPC/CPOC, current ability to achieve within 6 months of hire and recertify prior to expiration date, 
• Non-violent Crisis Intervention Comprehensive training class completed within 6 months of hire and recertify prior to expiration date, 
• Current American Health Association (AHA) Basic Life Support Card (BLS) within 6 months of hire and recertify prior to expiration date, 
• Mandatory Trainings for Organization and Advanced Health compliance completed within 3 months of hire, no later than 6 months, and recertify prior to expiration date. 
• Valid Oregon's Diver License 

Immunizations Required: 

• TB test (upon hire) 

Physical Requirements: 

• Prolonged periods sitting at a desk working at a computer. 
• Able to lift up to 20 pounds occasionally without assistance. 
• Able to travel as needed. 

 Benefits: 

• Competitive PTO Accrual (up to 193 hours of PTO accrual each year to start).  
• 7 Paid Holidays (You must be scheduled to work the holiday to qualify for holiday pay).  
• Medical/Dental/Vision (100% employer paid).  
• 401K Retirement Plan (6% match).  
• Options for long-term disability.  
• $50,000 Life Insurance Policy (options for additional voluntary life).  
• Additional Voluntary Critical Illness, Accident, and Hospital Indemnity coverage is available.  
• Employee Assistance Program (EAP).  
• Downtown Health and Fitness gym membership discount.  
• Headspace Care employer paid membership.