CLAIMS PROCESSING ASSISTANT

Join Our Team at AllCare Health

We Are Seeking Qualified Candidates! AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of 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.

Essential Duties

• 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

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education

High school diploma or general education degree (GED) required. College degree in an applicable field is preferred.

Experience

One to two years related experience and/or training in administrative and/or medical claims processing required. EZ-CAP claim processing system experience is highly preferred.

Technical Skills

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.

Interpersonal Skills

Reliable, confident, and effective in fostering positive relationships. Demonstrates accountability, inspires trust, and connects well with colleagues. Trustworthy, accountable, and skilled at collaborative engagement.

Language Skills

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.

Mathematical Skills

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.

Computer Skills

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.

Reasoning Ability

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.

On Call Responsibilities

This position does not have any on call responsibilities.

Supervisory Responsibilities

This position does not have any supervisory responsibilities.

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. The employee must be able to work onsite, as needed. The employee can work from a home office, occasionally.

Company Overview

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.

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 View phone number on click.appcast.io 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.