Certified Claims Processor I with AllCare Health in the Claims department.
This role is responsible for independently adjudicating professional claims in accordance with company policy, contract language, and applicable regulatory guidelines. The position applies coding knowledge and established claims processing standards to resolve standard and moderately complex claims while ensuring accuracy, compliance, and timely adjudication.
Key responsibilities include processing professional claims, reviewing claim edits and denials, coordinating benefits, resolving disputes and appeals, applying reimbursement methodologies, identifying claim processing trends, and communicating with internal teams and providers. The role also requires protecting PHI, maintaining production and quality standards, and participating in ongoing training to stay current with coding and regulatory changes.
Qualifications
- Associate's degree or equivalent combination of education and experience.
- 6 months to 1 year of related experience and/or training in medical terminology, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS.
- Experience with CMS-1500 and UB-04 claim forms.
- Current AAPC or AHIMA coding certification required (CPC or CPC-P).
- Familiarity with the healthcare industry.
- Excellent organization, time management, and computer skills.
- Knowledge of HIPAA regulations.
- Ability to work in a fast-paced environment and collaborate with a multidisciplinary team.
Additional skills
- Strong communication and customer service skills.
- Ability to prioritize work and meet deadlines.
- Adaptability, sound judgment, and attention to detail.
- Basic math, reasoning, and computer literacy skills.
- Must be able to work onsite as needed and may work from a home office occasionally.
Benefits and perks
- Competitive wages
- Excellent benefits package
- Affordable healthcare
- 401(k) retirement plan
- Wellness programs
- Flexible schedule options
- Monday-Friday schedule
- 1 hour unpaid lunch
- Two 15-minute paid breaks
Location
Oregon, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago