Claims Data Management Specialist II

Catholic Community Services of Western Washington - Portland, OR (30+ days ago)

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This position is responsible for a high volume of complex data and medical insurance claims processed through various Electronic Health Records (EHR) pertaining to contracts out of the Portland, Oregon office. Primary responsibilities include overseeing requests for authorizations supporting medical necessity/service eligibility (Medicaid) and ensuring authorization is granted by the Managed Care Organization (MCO), contract-specific data management, and working with MCO’s to ensure all aspects of processing are timely, complete and accurate. This position works under the direction of the Oregon Operations Manager.


  • Oversee authorization process; ensure clinical staff complete all information supporting Medical Necessity for service authorization. Negotiate changes and exceptions with utilization review department of each MCO to ensure compliance.
  • Create new consumer records in PsychConsult (FBH’s electronic health record) using eligibility information from MMIS, CIM3 (HSO), Optum Provider Express (UBH), and One Health Port (other private insurance).
  • Enter high volume of enrollment and discharge data into MOTS (Measures and Outcomes Tracking System) for all clients with OHP (Oregon Health Plan) coverage.
  • Complete high volume of timely and accurate data entry from psychiatrist, QMHP, Peer Partner, and QMHA direct service staff documentation into PsychConsult.
  • Create and maintain employee records in PsychConsult with DMAP (Medicaid) number and credentialing updates as needed.
  • Communicate employee DMAP, NPI and credentialing changes to PhTech.
  • Complete high volume of timely and accurate data entry into PsychConsult regarding changes in consumer services and consumer exits. Monitor and adjust coding as funder changes occur, including NCCI edits, credentialing, and per diem contract updates.
  • Assist CQI leadership in preserving data integrity for audit purposes.
  • Verify data input and coordinate with Oregon and Washington office staff to make appropriate corrections (batch error handler).
  • Oversee and advise new staff members making timely and accurate submission of invoicing for FSE and other contracts.
  • Oversee and provide monthly certification of data within contract parameters and verification through MMIS, CIM3 (HSO), Optum Provider Express (UBH), and One Health Port (other private insurance).
  • Recommend and participate in implementation of reporting and database management changes.
  • Develop and distribute reports to leadership, both routine and ad hoc from PsychConsult, including staff productivity, consumer outcome and service reports.
  • Develop and distribute reports to funders according to contract requirements regarding consumer outcome, service reports, and staff credentialing.
  • Track consumers by service type at intake and exit using current data collection system.
  • Support Quality Management with the collection and processing of information for internal and external stakeholders, such as satisfaction surveys, outcome information, etc.
  • Back up support for all tasks assigned to Claims Management Specialist.
  • Other duties as assigned.


  • Age 21 or older.
  • High School Diploma or equivalent.
  • One or more years of data entry experience.
  • Three or more years’ experience working in an office setting.
  • Strong computer skills especially in Outlook, Word, Excel and Access.
  • Good verbal and written communication skills.
  • Excellent organizational skills and ability to work in a busy and diverse environment.
  • Pass background checks through DHS, WA State Patrol and OR State Patrol.
  • Demonstrate effective verbal and written communication.
  • Ability to work both independently and as a member of a team.
  • Support and uphold the mission, beliefs and values of Catholic Community Services and Catholic Housing Services.
  • Demonstrates the necessary attitudes, knowledge and skills to deliver culturally competent services and work effectively in multi-cultural situations.


  • Experience with electronic medical records.
  • Knowledge of medical insurance claims management procedures and verbiage.
  • Ability to analyze consumer data and make recommendations.
  • Knowledge of accounting principles.
  • Knowledge of HIPAA guidelines.


We will not tolerate attitudes, behaviors, or statements that alienate, offend, or injure any person associated with CCS because of their racial or ethnic origin. We will enable and support all efforts to become aware of and eliminate racism and racist behaviors within CCS and the broader community. We will take exceptional steps to identify and root out such biases, especially where there appear to be long standing, institutional patterns of unacceptable behavior or lack of performance.

Job Type: Full-time

Salary: $18.36 /hour


  • High school or equivalent