Insurance Billing and Coding Specialist for Central Admin in NE Portland

The Oregon Clinic•Portland, OR

12d•Hybrid

About The Position

Join The Oregon Clinic as an Insurance Billing & Coding Specialist (Hybrid/Remote) and make an impact in patient-focused healthcare. This role is based at the Central Administration office in NE Portland, with hybrid/remote work available after training. You will work alongside a collaborative team, contributing to the mission of delivering world-class care with kindness and empathy. Your primary duties involve ensuring compliance with coding regulations, maximizing reimbursement, processing claims, and verifying insurance coverage. You will assign CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and modifiers, review coding, follow up on claim denials, investigate billing problems, and communicate with stakeholders to resolve issues. The role may also involve posting payments and adjustments and updating records.

Requirements

Must live in SW Washington or the Portland area to come on-site to support projects as needed.
Business and computer courses at the college level; an Associate's degree is strongly preferred.
Current certification from a national accredited body that credentials professional coders is required.
CPC required.
Must maintain coding certification and participates in continuing education units every 2 years for verification and authentication of expertise
Minimum five (5) years of Medical Accounts Receivable and Coding experience is required.
Prior Electronic Medical Record (EMR) experience with EPIC is required.
Prior experience with complex healthcare appeals is required.
Knowledge of CPT procedure and ICD-10 diagnosis coding, advanced principles of accounts receivable management, and overall billing functions in a medical clinic setting.
Knowledge of overall healthcare payment system (FFS, PPOS, HMOs, capitation, etc.) and national and regional payers.
Proficient with Microsoft Office Suite.
Strong analytical, organizational, and time management skills.
Demonstrated ability to initiate, work independently, and effectively multitask.
Excellent attendance and work ethic.
Positive attitude and desire to be a team player.
Ability to communicate professionally and effectively with patients, physicians and other team members.
A commitment to patient-focused care, privacy, and safety.
Offers are contingent on successful completion of drug and background screenings.

Nice To Haves

American Academy of Professional Coders (AAPC) certification is preferred.
Outlook and Teams are preferred.

Responsibilities

Responsible for ensuring that all procedural and diagnostic codes used by TOC comply with all application rules, State & Federal laws, and healthcare industry standards to maximize reimbursement within the legal and ethical constraints.
Ensuring the accuracy of all claims submitted, performing follow-up on accounts that are not paid timely or appropriately, processing account adjustments, and verifying insurance coverage.
Assigns CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and modifiers to physician services, ensuring appropriate and accurate billing per documentation and coding guidelines.
Reviews coding as requested and provides corrections and feedback to the requestor.
Follows up on claim denials, resubmits, or appeals as appropriate.
Investigates billing problems and formulates solutions.
Communicates effectively with coworkers/leadership/payor on large impact denial projects, providing information as requested to resolve, and tracks progress to resolution.
May post payments and adjustments or changes as needed from remittance advice or EOBs.
Updating records as needed.
Other duties as assigned.