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Claim Analyst & Process Improvement Coordinator

locationSalem, MA, USA
PublishedPublished: 1/5/2025
Project Management / Professional Services
Full Time
$4,207 - $5,842 per month

Initial Posting Date:

01/03/2025

Application Deadline:

01/13/2025

Agency:

Oregon Health Authority

Salary Range:

$4,207 - $5,842

Position Type:

Employee

Position Title:

Claim Analyst & Process Improvement Coordinator

Job Description:

Do you have experience supporting the implementation of policies, projects and programs at the community, state, or national level? Do you enjoy assisting the team and manager in developing planning tools and providing data synthesis, analysis and reporting to facilitate collaboration and decision-making? We look forward to hearing from you!

Click Here 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 OHA's Health Systems Division). 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 one (1) permanent, full-time position. The position is classified and is represented by a union. 

Work Location: Salem/Marion; hybrid position.

What you will do!

This position involves maintaining Electronic Data Interchange (EDI) registration efforts, processing Fee For Services (FFS) claims, handling Trading Partner Agreements (TPA), configuring the Medicaid Management Information System (MMIS) for electronic claims, an collaborating on process improvements. It requires knowledge of contracting, Medicaid laws, and experience in designing and monitoring large projects. 

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 WE ARE LOOKING FOR:

Minimum Qualifications

Three years of secretarial or administrative support experience that includes coordinating office procedures, preparing narrative and statistical reports, and administrative data collection and analysis;

OR

An associate degree in general office occupations and two years of secretarial or administrative support experience that includes coordinating office procedures, preparing narrative and statistical reports, and administrative data collection and analysis;

OR

An equivalent combination of education and 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 experience in working with Community Mental Health Programs, Behavioral Health Service Providers, Coordinated Care Organizations or other managed care entities.
  • Experience within the context of healthcare claims processing.
  • Experience analyzing complex, detailed problems within the context of an extremely automated, highly complex Information System, such as the Medicaid Management Information System (MMIS).
  • Ability to explain and offer expert level technical assistance on rules, policy, and procedures.
  • Ability to demonstrate advanced Microsoft Excel, Word, Outlook, and use of collaboration tools such as Microsoft Teams, SharePoint and Smartsheet.
  • Demonstrates skills in the following areas:
    • Community and Partner Engagement
    • Constructive and Collaborative Working Relationships
    • Customer Service and Person-centered Engagement
    • Critical Decision-making and Problem-solving
    • Data Synthesis, Analysis and Reporting
    • Performance / Process / Quality Improvement
    • Project Coordination and Monitoring
    • Team Collaboration & Group Facilitation
    • Expert level Technical Assistance
    • Written and oral communication, including preparation of reports and presentations.

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 medical, vision and dental 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: https://www.oregon.gov/oha/pebb/pages/alex.aspx  
  • 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
  • Pension and retirement programs
  • Optional benefits include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
  • Click here to learn more about State of Oregon benefits.

How to apply:

  • Complete the online application
  • Attach a Cover Letter, no more than 2 pages, specifically focused on your qualifications for this position as identified in the Desired Attributes section of this announcement. Please note: a cover letter is not required for your application to be considered; however, cover letters are reviewed as part of candidate prioritization and selection for interviews. A cover letter provides you the opportunity to clearly state your interest in the position, and what aspects of your professional and lived experience you believe are relevant to the role.
  • Please ensure you’ve provided a thorough and updated application as it pertains to the position for which you are applying. Update professional, educational, voluntary, and personal experience on your resume. Your application materials will be used to determine salary based on a pay equity assessment.  For further information, please visit the Pay Equity Projecthomepage.

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 here, to learn more about OHA’s mission, vision and core values.

Questions/Need Help?

If you need assistance to participate in the application process, including an accommodation request under the American with Disabilities Act contact: Stephanie Mitchell at Voice: [503-979-7679] (TTY 711) or Email: stephanie.d.mitchell@oha.oregon.gov.

TTY users  may dial 711 or 1-800-735-2900.

For Workday technical support dial 1-855-524-5627.

Additional Information

  • Please monitor your Workday account, as all communication will be sent to your Workday account. You must have a valid e-mail address to apply.
  • Candidates gathered from this job announcement may be used to fill future vacancies.
  • If you are a veteran, you may receive preference. Click here for more information about veterans’ preference. If you checked that you are a veteran, we will ask you for your documents later in the process.
  • Oregon Health Authority (OHA) does not offer VISA sponsorship. Within three days of hire, you will be required to complete the US Department of Homeland Security’s I-9 form confirming authorization to work in the United States.  OHA is an E-Verify employer and will use E-Verify to confirm that hires are authorized to work in the United States.
  • If you are offered employment, the offer will be contingent upon the outcome of an abuse check, criminal records check and driving records check, and the information shall be shared with the Oregon Health Authority (OHA), Office of Human Resources (OHR). Any criminal or founded abuse history will be reviewed and could result in the withdrawal of the offer or termination of employment.
  • Please only attach documents that are related to the position. Additional documents that are attached will not be reviewed.
  • Attention current State of Oregon employees: To apply for posted positions, please close this window and log into your Workday account and apply through the Career worklet.
  • Applicant Help and Support webpage

The Oregon Health Authority is committed to fair employment practices and non-discrimination, including pay equity for all employees. We do not discriminate on the basis of protected class (race, sex, veteran status, disability, age, color, religion, national origin, marital status, sexual orientation) in the payment of wages or screen applicants on the basis of their current or past compensation. We determine salary by completing a review of your application materials to evaluate your related education, experience, and training for this position.

The Oregon Health Authority is an equal opportunity, affirmative action employer committed to work force diversity and anti-racism.

Salary range

  • $4,207 - $5,842 per month