Oregon Healthcare Claims Specialist

Job Summary

A company is looking for a Healthcare Claims Appeals Specialist.

Key Responsibilities

• Review and analyze provider billing disputes and appeals
• Coordinate with clinical reviewers and coding specialists to support appeal determinations
• Manage and track a caseload of appeals, ensuring compliance with timelines and quality standards

Required Qualifications

• 4+ years of experience in healthcare claims, appeals, or clinical operations
• Strong knowledge of medical terminology and coding systems (CPT, ICD, HCPCS)
• Coding certification strongly preferred
• Proven ability to analyze complex claims issues and interpret policies
• Experience working with claims processing systems and proficiency in Microsoft Office tools