Medical Review Coordinator

  • Oregon Health Authority
  • Keizer, OR
  • Oct 08, 2020
Full time Medical Other

Job Description

The Oregon Health Authority has a fantastic opportunity for a Registered Nurse with strong medical records experience to join an excellent team, provide integral medical reviews and work to advance their Medicaid operations. 

 

This position falls under the Classification Medical Review Coordinator. 

 

 

WHAT YOU WILL DO!

The mission of the Oregon Health Authority (OHA) Fiscal and Operations Divisions/ Office for Program Integrity/ Program Integrity Audit Unit is to ensure program integrity of the Medicaid programs.

 

As a Medical Review Coordinator, you will perform an integral function conducting compliance audit of providers and contractors participating in programs for OHA and the Department of Human Services (DHS).

 

In this role, you will apply medical expertise in auditing the most complex provider records using applicable state, federal and OHA/DHS rules. You will support Program Integrity mandates, by performing audits that examine the medical necessity of Medicaid and Medi-Medi services. You will consult with the Medical Director, physicians, and other medical providers about various complex diagnostic issues and procedure codes, to accurately and properly audit providers or contractors. You will also support an entire operation by providing licensed medical necessity guidance and subject matter expertise.

 

The audit function in Program Integrity is designed to deter medical program fraud and abuse, and to monitor and ensure provider and contractor compliance with Federal, State, and Agency rules and regulations.

 

 

WHAT WE ARE LOOKING FOR:

  • A current Registered Professional Nurse license issued by the Oregon State Board of Nursing at the time of appointment and maintained throughout employment; AND Three (3) years of nursing experience that includes review of medical records.
  • Experience working in a team environment.
  • Experience working independently with minimal supervision.
  • Extensive knowledge of auditing techniques such as analytical review procedures, statistical sampling and other data mining methodologies.
  • Experience with risk analysis for evaluation of internal and management controls.
  • Experience with treatment modalities, health care coding procedures and various practices within the medical provider community.
  • Experience in auditing procedures and data assessment for researching, writing and finalizing audits.
  • Experience with or knowledge of state agency programs, public and commercial insurance programs and procedures and the medical provider community.
  • Knowledge of and experience in applying medical terminology and healthcare coding procedure to auditing work.
  • Certification as a healthcare coder/ auditor; i.e. CPC, COC, CIC, CPC-P, CPMA or other recognized certifications preferred.
  • Experience with Medicaid Program Integrity preferred.
  • Experience as a registered nurse in the state of Oregon or other states.
  • Experience in state government policies and procedures for Health Care programs.
  • Experience in promoting a culturally competent and diverse work environment.

 


WHAT’S IN IT FOR YOU?

We offer a workplace that balances productivity with enjoyment; promote an atmosphere of mutual respect, dedication, and enthusiasm. You will collaborate in an open office with a team of bright individuals to work with and learn from. We offer full medical, vision and dental with paid sick leave, vacation, personal leave and ten paid holidays per year plus pension and retirement plans. If you're driven by the passion to do something meaningful that changes lives, the Oregon Health Authority is the place for you.

 

This is a full-time, permanent position that is classified and represented by SEIU.  

The Oregon Health Authority is committed to developing and promoting culturally and linguistically appropriate programs and a diverse and inclusive workforce representing the diversity, culture, strengths and values of the people of Oregon. Click here, to learn more about OHA’s mission, vision and core values. OHA is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, genetic information or any other protected class under state or federal law.

Occupations

General-Other: Medical-Health

URL

Salary

$71,724 - $103,932 per year