Encounter Data and Reconciliation Coordinators – two

Do you have experience providing data synthesis, analysis and reporting within the context of healthcare claims processing? Do you enjoy conducting root cause analyses and summarizing insights to facilitate collaboration and decision-making? We look forward to hearing from you

This is a Pool Recruitment, which means that applicants are able to be considered for all of the positions linked to this posting. As candidates successfully move through the recruitment process, they will have the opportunity to express which positions are of most interest.

to view a Dashboard of all current recruitments for the Behavioral Health Division, Medicaid Division, and the Office of Data Strategy & Operations (which were previously all part of ). The specific positions associated with this posting are listed under REQ-160445. The dashboard identifies the business area (“Section”) and Unit for each position and also provides a link to a position description to offer you greater context for the role. Section 1 of the position description outlines Position Information, including Work Location and Supervisor Name. Section 3 outlines the Description of Duties.

This posting will be used to fill two (2) permanent, full-time positions. These positions are classified and are represented by a union. 

Work Location: Salem/Marion; hybrid position

What you will do

Coordinated Care Organizations (CCO) Reconciliation Coordinator. The primary purpose of this position is to ensure the reconciliation between the Monthly Enrollment File (834) sent by the Oregon Health Authority (OHA) Medicaid Division and CCOs is completed monthly.  This position analyzes discrepancies, systematic or otherwise between Medicaid and the contractors.  This position analyzes enrollment into the CCOs and proposes potential procedures for completing those reviews thoroughly, making recommendations for enrolling, disenrolling, and possibly recouping capitation. Capitation is the payment that is made monthly to the CCOs so they will provide services to Oregon Health Plan (OHP) members. When enrollment issues are found, this position will do deep analysis in multiple systems to identify the cause and potential necessary solutions.

Encounter Data Coordinator/Senior Claims Analyst. The primary purpose of this position is to ensure that Encounter Data and Fee-For-Service claims are processed according to related Code of Federal Regulations (CFRs), Oregon Administrative Rules (OARs), and contractual requirements.

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

The OHA mission is helping people and communities achieve optimum physical, mental, and social well-being through partnership, prevention and access to quality, affordable health care. OHA’s work is organized into three broad goals: Improve the lifelong health of all Oregonians, increase the quality, reliability, and availability of care for all Oregonians and lower or contain the cost of care so it is affordable to everyone.

What's in it for you?
Oregon Health Authority is a team of passionate individuals working to promote health across the lifespan of individuals, families, and communities. We value and support unique perspectives using a trauma-informed approach and aim to reflect these values in our hiring practices, professional development, and workplace.

• We offer exceptional benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs. Try this free virtual benefits counselor by clicking here:  
• Paid Leave Days:
  • 11 paid holidays each year
  • 3 additional paid "Personal Business Days" each year
  • 8 hours of paid sick leave accumulated every month
  • Progressive vacation leave accrual with increases every 5 years
• Optional benefits include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
• Click to learn more about State of Oregon benefits.

OHA values health equity, service excellence, integrity, leadership, partnership, innovation and transparency. OHA’s health equity definition is “Oregon will have established a health system that creates health equity when all people can reach their full potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances. Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address: the equitable distribution or redistributing of resources and power; and recognizing, reconciling, and rectifying historical and contemporary injustices.” OHA’s 10-year goal is to eliminate health inequities. Click , to learn more about OHA’s mission, vision and core values.

WHAT WE ARE LOOKING FOR:

Minimum Qualifications

Any combination of experience and education equivalent to three years professional-level evaluative, analytical and planning work.

Example:

A Bachelor's Degree or higher in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills will substitute for all work experience. An Associate’s will substitute for 18 months of experience.

Desired Attributes

• Evidence of ongoing development of personal cultural awareness and humility, and knowledge of social determinants of health and their impacts on health outcomes.
• Experience factoring in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.
• Knowledge of Oregon Administrative Rules and Oregon Revised Statutes, other applicable regulations, and program requirements.
• Knowledge of health services delivery systems, particularly the Oregon Health Plan/ Medicaid administration in Oregon and relational landscape of key partners, providers, community based organizations, and advocacy groups.
• Knowledge of Medicaid Management Information System (MMIS) functionality.
• Experience within the context of healthcare claims processing, including medical and dental billing and coding practices.
• Ability to explain and offer expert level technical assistance on rules, policy, and procedures.
• Experience developing and providing planning tools, documents, data, and meeting coordination to facilitate collaboration and decision-making.
• Ability to demonstrate advanced Microsoft Excel, Word, Outlook, and use of collaboration tools such as Microsoft Teams and SharePoint.
• Demonstrates skills in the following areas:
  • Constructive and Collaborative Working Relationships
  • Customer Service and Person-centered Engagement
  • Issue Identification and Resolution
  • Research and Root Cause Analysis
  • Data Synthesis, Analysis and Reporting
  • Performance / Process / Quality Improvement
  • Expert level Technical Assistance
  • Written and oral communication, including preparation of reports