Claims Specialist jobs in Eugene, OR

Greater Oregon Behavioral Health, Inc. (GOBHI) has an immediate opening for a full-time Claims Analyst. This position will be based out of the employee’s home office, which can be located within the State of Oregon.

The Claims Analyst is responsible for ensuring the accuracy, timeliness, and compliance of healthcare claims data. This role involves monitoring and managing encounter data submissions, resolving data issues, and coordinating with internal and external stakeholders to maintain efficient claims processing.

Essential duties include:

• Coordinate with Moda Health, Community Mental Health Programs (CMHPs), the Oregon Health Authority (OHA) and other partners to ensure accurate and timely processing of pre-authorizations and claims.
• Work closely with claims processors and Utilization Management staff to address claim-related issues.
• Analyze encounter data submission to identify potential issues and trends.
• Coordinate and perform corrections to data rejections to ensure timely resubmission.
• Monitor EDI file transfers to identify and resolve issues with automated processes.
• Facilitate daily, weekly, and monthly file transfers for CCO business operations and vendor support.
• Collaborate with OHA and other partners to implement changes in EDI file transfers.
• Assist with EOCCOs annual External Quality Reviews and Information System Capability Assessments.
• Support major software transitions and data needs for related projects.
• Ensure compliance with industry standards and regulatory requirements.
• Prepare monthly reports for Finance from GOBHI’s data warehouse.
• Respond to ad-hoc data requests from Finance, UM, and other internal departments.
• Participate in monthly CCO System Technical meetings and coordinate the Quarterly EOCCO BH Encounter Data Workgroup.
• Provide technical assistance to GOBHI staff.
• Maintain strong relationships with internal and external stakeholders, including members, partners, and vendors.
• Serve as a resource for GOBHI staff and contracted providers on behavioral health coding and claims processing.
• Other duties as assigned.

What is needed to succeed in this role:

• Two years experience in healthcare claims processing, healthcare billing, data analysis, or similar related field.
• Experience with EDI file transfers (837, 834 processes), encounter data, and behavioral health coding (CPT, HCPCS, ICD-10) preferred.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving skills.
• Proficiency in MS Office Suite and Google Workspace.
• Experience with SQL, PostgreSQL, and/or database management.
• Project management skills.
• High attention to detail and organizational abilities.
• Ability to work independently and as part of a team.
• Flexibility to adapt to changing priorities and deadlines.
• Knowledge of healthcare claims processing, coding, and regulatory requirements.
• Education – Associate’s degree in healthcare, business or information systems or a closely related field.

What we offer:

• Competitive salary – starting at $62,000.00 annually
• Additional bilingual compensation available
• Medical, dental and vision insurance for you and dependents
• Generous paid time off
• Company paid life and long-term disability insurances
• EAP
• FSA, with a $500 employer contribution
• Triple AAA insurance
• Mileage reimbursement
• Wellness benefits
• 401k contribution, including 6.5% employer contributions
• Cell phone and internet reimbursements

About GOBHI:

Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon.

GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services.