Remote Claims Processor Jobs in Portland, OR (NOW HIRING)

Make an Impact at The Oregon Clinic! Premium Benefits, Competitive Pay, and Inspiring Purpose

Join us at The Oregon Clinic as an Insurance Billing & Coding Specialist (Hybrid/Remote). Must live in SW Washington or the Portland area to come on-site to support projects as needed. Work alongside a collaborative team of patient-focused colleagues in our thriving Central Administration office.

Every person at TOC makes a difference in our mission of delivering world-class care with kindness and empathy. As a member of our team, you have the opportunity to make a valuable impact within the local community and our ecosystem of care. By providing patients and internal and external stakeholders with a consistent, efficient, and easy experience, you’ll help ensure that patients at The Oregon Clinic receive the highest value care tailored to their needs.

Using excellent customer service and communications skills, your primary duties in this role include:

• Responsible for ensuring that all procedural and diagnostic codes used by TOC comply with all application rules, State & Federal laws, and healthcare industry standards to maximize reimbursement within the legal and ethical constraints.
• Ensuring the accuracy of all claims submitted, performing follow-up on accounts that are not paid timely or appropriately, processing account adjustments, and verifying insurance coverage.
• Assigns CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and modifiers to physician services, ensuring appropriate and accurate billing per documentation and coding guidelines.
• Reviews coding as requested and provides corrections and feedback to the requestor.
• Follows up on claim denials, resubmits, or appeals as appropriate. 
• Investigates billing problems and formulates solutions.
• Communicates effectively with coworkers/leadership/payor on large impact denial projects, providing information as requested to resolve, and tracks progress to resolution.
• May post payments and adjustments or changes as needed from remittance advice or EOBs.
• Updating records as needed.
• Other duties as assigned.

Salary:

Hiring range, based on experience and credentials: $27.46-$37.16 per hour.

Workdays: This position is based at the Central Administration office but primarily allows for Remote work. Hybrid/Remote work is available once training is completed and expectations are met. Typical hours are Monday-Friday, (7:30 am-4:00 pm, Pacific Standard Time (P.S.T.))

Qualifications that support success in this role are based on education, experience and values including:

• Business and computer courses at the college level; an Associate's degree is strongly preferred.
• Current certification from a national accredited body that credentials professional coders is required. American Academy of Professional Coders (AAPC) certification is preferred.
• CPC required. Must maintain coding certification and participates in continuing education units every 2 years for verification and authentication of expertise
• Minimum five (5) years of Medical Accounts Receivable and Coding experience is required.
• Prior Electronic Medical Record (EMR) experience with EPIC is required. 
• Prior experience with complex healthcare appeals is required. 
• Knowledge of CPT procedure and ICD-10 diagnosis coding, advanced principles of accounts receivable management, and overall billing functions in a medical clinic setting.
• Knowledge of overall healthcare payment system (FFS, PPOS, HMOs, capitation, etc.) and national and regional payers.
• Proficient with Microsoft Office Suite. Outlook and Teams are preferred.
• Strong analytical, organizational, and time management skills.
• Demonstrated ability to initiate, work independently, and effectively multitask.
• Excellent attendance and work ethic.
• Positive attitude and desire to be a team player.
• Ability to communicate professionally and effectively with patients, physicians and other team members.
• A commitment to patient-focused care, privacy, and safety.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. 

Make an impact in patient-focused healthcare. Look forward to coming to work and feel good about the work you do - apply today!

Premium Benefits: 

• Healthcare: Employee is 100% covered Medical, Dental, and Prescription Insurance
• Financial Wellbeing: Generous 401(k) plan and Flexible Spending Account options
• Work-Life Balance: Paid Time Off plus 9 paid holidays annually
• Wellness Support: Robust wellness program and employee assistance services
• Commuter Benefits: 70% of Tri-Met transit pass covered
• Additional Perks: Employee discounts and optional benefits like Pet Insurance

Patients and peers recognize The Oregon Clinic as a top regional healthcare provider and employer. We are:

• Guided by our values of dedicating to excellence, compassionate and joyful connection, inclusive collaboration, listening humbly, and leading with integrity.
• The largest physician-owned, multi-specialty medical and surgical practice in Oregon with a team of 1,500 team members across 30 specialties and our business office.
• Dedicated to providing the highest value care tailored to the needs of each unique patient.
• Proud to be consistently ranked by our employees as a Top 10 Workplace by The Oregonian.

Our Commitments: 

• Diversity, Equity, & Inclusion: We are more than an Equal Opportunity Employer. We welcome and embrace differences and a diversity of backgrounds. Our goal is for patients, physicians, and team members to see and feel diversity, equity, safety, and inclusion in all aspects of their interactions with TOC clinics and administration.
• A safe workplace: We are an alcohol and drug-free workplace for the safety of our patients and employees. Offers are contingent on successful completion of drug and background screenings.