Medical Claims Jobs in Oregon
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Search Results - Medical Claims Jobs in Oregon
Providence Non-RN - Oregon-Portland
Technician.
• 2 years experience with insurance verification, medical claims processing, insurance member enrollment or customer service.
• 2 years experience as a pharmacy technician in a specialty setting (e.g. Long Term Care, Infusion or Specialty Pharmacy...
Remote
stakeholders.
Preferred Qualifications:
• Healthcare industry experience.
• Strong understanding of software development life cycles.
• Knowledge of NCQA, HEDIS & CMS Stars.
• Basic knowledge of IT applications, data processing, and medical claims...
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Remote
in the Healthcare industry of enrollment, medical claims and/or pharmacy claims.
• Proficient in Microsoft Office Suite applications PowerPoint, Word, Excel and Outlook.
• Flexible work schedule.
• Experience with project management tools like JIRA.
• Strong...
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Remote
solve.
• Ability to work independently within appropriate programs after training.
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Excellent verbal and written communication skills for upward and downward conversations
Physical and Mental...
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Remote
ICU/ED, or similar setting)
• Utilization review/utilization management experience preferred
Technical Skills:
• Proficiency with Microsoft Word, Excel, and Outlook
• Working knowledge of ICD-10, CPT, and HCPCS coding and medical claims
• Ability...
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Remote
and the appropriateness of treatment setting and services delivered.
This position will start on October 5, 2026 and will be in scheduled group training for the first 12 weeks.
Responsibilities:
• Analyzes and Audits Claims. Integrates medical chart coding principles...
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Remote
outpatient, ancillary, and inpatient pre-certification requests, including mental health, substance abuse, skilled nursing, and rehab stays, for medical appropriateness and necessity.
• Drive post-service reviews: Evaluate post-claim and post-service requests...
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and the appropriateness of treatment setting and services delivered.
Start date is 8/31/2026 or 10/5/2026
Responsibilities:
• Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit...
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Remote
on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered.
Responsibilities:
Audits Outpatient and Specialty Claims:
• Utilizes medical chart coding principles and client specific guidelines...
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Remote
years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• 3-5 years...
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Remote
Overview:
This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this role will be doing DRG Validation for our prepay and retrospective audits and making determinations without a medical record...
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Remote
of treatment setting and services delivered.
Responsibilities:
• Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise...
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