Hiring: Medical Claims Reviewer Company: Acentra Health Location: Oregon, United States Job Posted Time: 2026-09-10 11:00:30 Employment Type: Contract Target Skills & Keywords : CPT, HIPAA, Medicaid, Medical Coding, Medicare, Microsoft Excel, Microsoft Office, Visio About the job Experience: •2+ years of experience in medical claims review, healthcare operations, Medicaid administration, compliance, medical coding and billing or related healthcare functions. Required Skills: •Acentra Health is looking for a Medical Claims Reviewer to join our growing team. •Review claims, medical records, billing, and supporting documentation prior to payment to make accurate coverage and payment determinations. •Audit claims and records for compliance with CPT guidelines, Medicaid requirements, Oregon Health Plan policies, federal and state regulations, and applicable program rules. •Identify and investigate billing irregularities, errors, inconsistencies, services not provided, misrepresentations, inappropriate coding, potential fraud, and documentation concerns. •Investigate and resolve denied claims, billing appeals, exception requests, provider disputes, reimbursement issues, and coverage inquiries. •Research and respond to inquiries regarding compliance, coding, denials, billable services, coverage, reimbursement, documentation, and program requirements. •Independently manage inpatient and outpatient claims while ensuring timely and appropriate reimbursement. •Actively facilitate and support resolution of provider issues and serve as a resource to internal staff, providers, contractors, and other stakeholders. Qualifications: •Bachelor's Degree. •Current coding certification from AAPC or AHIMA as a CPC, COC, CIC, or CPMA. •Knowledge of statutory regulations, medical terminology, medical coding systems, auditing concepts, billing procedures, and documentation requirements. •Understanding of the State MMIS system, Medicaid operations, and the claims release process. •Domain knowledge of Medicare, Medicaid, or healthcare operations. •Strong analytical, critical thinking, problem-solving, and process improvement skills, including the ability to understand business needs, analyze processes, identify solutions, and make recommendations. •Strong attention to detail and the ability to manage multiple assignments in accordance with project demands. •Initiative, enthusiasm, creativity, flexibility, and resourcefulness when handling assignments. •Demonstrated capacity to work effectively with multiple groups and willingly share time, knowledge, and information with others. •Excellent written and verbal communication skills, including the ability to explain technical information to providers, clients, staff, and stakeholders at all levels. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!