Medical Claims Auditor at AllCare Health with the Claims department in Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary

The medical auditor is responsible for ensuring chart audits are completed in an efficient and timely manner by performing and assisting with the following duties:

Essential Duties

• Reviews professional chart documentation for accuracy against the billed claim(s).
• Ensures appropriate coding, CCI and MUE edits.
• Reviews chart for supporting documentation for E&M code levels and CPT/HCPCS codes.
• Provides detailed written reports to management level staff and prepares detailed reports for presentation to the provider.
• Performs routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration.

Education

• One-year certificate from college or technical school; or three to six months related experience and/or training; or equivalent combination of education and experience.

Skills and Experience

• 3-5 years’ experience in coding, medical record auditing (hospital chart auditing preferred).
• At least 1 year of medical auditing experience.
• Familiarity with ICD 10 CM/ICD-10-PCS and CPT/HCPCS procedure codes.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Detailed knowledge of medical coding systems, procedures, and documentation requirements.
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.

Certificates, Licenses, and/or Registrations

• Certified Professional Medical Auditor (CPMA) or its equivalent

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.
• The employee must be able to work onsite, as needed.
• The employee must be able to work from a home office, as needed.

Company Overview

AllCare Health Website: https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.