Certified Claims Processor I

AllCare Health

. Independently adjudicate professional CMS-1500 claims using benefits, pricing, coding guidelines, and contract terms .

Posted 9/30/2026full-timeGrants Pass • Oregon • United StatesJunior💰 $20 - $24 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in adjudicating CMS-1500 claims, applying CPT, HCPCS, and ICD-10 coding, while ensuring compliance with HIPAA regulations. Proficient in analyzing claim data and resolving discrepancies to maintain high productivity and quality standards.

Highest-signal resume keywords

CMS-1500 Claims AdjudicationCPT, HCPCS, ICD-10 CodingAAPC or AHIMA Coding CertificationMedical TerminologyHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisReimbursement MethodologiesFee SchedulesCoding GuidelinesData InterpretationMathematical CalculationsClaim ProcessingEligibility VerificationBilling Error ResolutionContract Language Application

Soft Skills

Excellent Organization SkillsTime-Management SkillsEffective CommunicationProblem-Solving SkillsAttention to Detail

Tools & Technologies

Microsoft Office SuiteEZ-Cap

Certifications & Qualifications

CPCCPC-P

Industry Keywords

Healthcare IndustryClaim FormsPolicy MisalignmentAuthorization RequirementsProvider Disputes

About the role

Key responsibilities & impact

Independently adjudicate professional CMS-1500 claims using benefits, pricing, coding guidelines, and contract terms
Apply CPT, HCPCS, ICD-10 coding, benefit plans, and contract language to determine claim outcomes, pricing, payments, and denials
Review and resolve pending claims, edits, denials, adjustments, and reprocessing requests
Analyze claim and line-level data to identify coding discrepancies, system configuration issues, policy misalignment, eligibility discrepancies, authorization requirements, and billing errors
Coordinate benefits by reviewing member eligibility, other insurance information, and payer responsibility
Review provider disputes, reconsiderations, and appeals and determine whether reprocessing or adjustment is warranted
Apply reimbursement methodologies, fee schedules, and pricing logic
Identify recurring claim-processing issues and escalate findings to leadership
Communicate with internal teams and providers to clarify claim details and resolve processing issues
Maintain HIPAA and PHI confidentiality and security
Follow claim routing, inventory control, and workflow procedures
Participate in ongoing training and continuing education
Meet productivity, quality, turnaround-time, attendance, and production standards
Take direction from Department leadership and perform other duties as assigned
No on-call or supervisory responsibilities

Requirements

What you’ll need

Associate's degree (AA) from a two-year college or technical school, or equivalent combination of education and experience
Six months to one year of related experience and/or training in Medical Terminology, ICD-10-CM, ICD-10-PCS, Current Procedural Terminology, Healthcare Common Procedure Coding Systems, CMS-1500, UB-04, and other claim forms
Current AAPC or AHIMA Coding Certification required (CPC, CPC-P)
EZ-Cap experience preferred
Familiarity with the healthcare industry
Excellent organization and time-management skills
Excellent computer skills, including Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel)
Knowledge of and compliance with HIPAA regulations
Ability to work onsite, as needed
Ability to perform essential job duties with or without reasonable accommodation
Ability to read and comprehend simple instructions, correspondence, and memos
Ability to write simple correspondence and present information effectively
Ability to perform basic mathematical calculations and interpret bar graphs
Advanced basic computer skills, including email, document composition, database entry, presentations, form downloads, and data backup
Ability to apply common sense to detailed written or oral instructions
Ability to work with problems involving a few concrete variables in standardized situations
Ability to occasionally lift or move up to 10 pounds
Punctual, regular, and predictable attendance

Benefits

Comp & perks

Affordable healthcare
401k retirement
Wellness programs
Flexible schedule options
One hour unpaid lunch
Two 15-minute paid breaks