Description
Here at GOBHI, we understand and support diversity by appreciating it and encouraging it by creating a culture of dignity and respect for our employees. We are honored to be an Equal Opportunity Employer.
We have multiple job ads for this position, please only apply to one.
GOBHI has an immediate opening for a full-time Medicaid Claims Analyst. This remote position will be based out of the employee’s home located in the state of Oregon or accepted radius.
The Medicaid Claims Analyst supports GOBHI’s Non-Emergent Medical Transportation (NEMT) program by reviewing, processing, and reconciling Medicaid claims to ensure accuracy, compliance, and timely reimbursement. This position is responsible for coding, billing, auditing, and reconciliation functions related to NEMT services, serving as a key liaison between transportation providers, internal staff, and state Medicaid offices. This role ensures that all claims activities comply with federal and state regulations while supporting program efficiency, accuracy, and integrity.
Essential duties include:
- Review, validate, and process NEMT claims in accordance with Medicaid policies, GOBHI program guidelines, and contractual requirements.
- Perform accurate billing and coding for NEMT claims using appropriate HCPCS/CPT codes.
- Verify member eligibility, trip authorization, and service documentation prior to submission.
- Ensure claims are submitted within required timelines and track adjudication through final payment.
- Identify and resolve claim errors, discrepancies, and denials in coordination with providers and program staff.
- Maintain current knowledge of Medicaid billing codes, guidelines, and NEMT-specific requirements.
- Conduct regular audits of NEMT claims to detect and prevent errors, overpayments, or potential fraud.
- Support corrective action plans and recommend process improvements to strengthen billing integrity.
- Accurately code trips and services in compliance with Medicaid and NEMT guidelines.
- Prepare, review and submit billing batches to Medicaid and other payers.
- Reconcile claims against payments, identifying variances or unpaid balances.
- Collaborate with GOBHI finance staff to support accurate accounting and reporting.
- Generate and maintain reports on claims activity, denial rates, and reimbursement trends.
- Provide data analysis to identify cost drivers, claim patterns, and areas for improvement.
- Serve as a resource for NEMT providers regarding Medicaid billing procedures, documentation, and claim resolution.
- Upon supervisor’s approval and direction, update and maintain provider rate contracts.
- Provide training and technical assistance to providers on coding, billing, and submission processes.
- Other duties as assigned.
Requirements
What is needed to succeed in this role:
- Two years’ experience in Medicaid claims processing, billing, or healthcare reimbursement.
- Experience working in transportation claims strongly preferred.
- Knowledge of Medicaid billing, HCPCS/CPT coding, and claims submission requirements.
- Strong analytical skills and attention to detail.
- Excellent problem-solving, communication, and organizational abilities.
- Handles highly sensitive and confidential information and complies with HIPAA requirements.
- Technology savvy, proficient using MS software and Google Suites.
- Experience with claims management systems, billing software, and Microsoft Excel.
- Capacity to handle multiple priorities and meet strict deadlines.
- Education – Associate’s degree in Business, Accounting, Healthcare Administration, or a related field. Bachelor’s degree preferred.
What we offer:
- Competitive salary – starting at $27.88 DOE
- Medical, dental and vision insurance for you and dependents
- 22 paid time off days and 12 paid holidays
- EAP
- FSA, with a $500 employer contribution
- Triple AAA insurance
- Mileage reimbursement
- Wellness benefits
- 401k contribution, including 6.5% employer contributions
- Cell phone and internet reimbursements
About GOBHI:
Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon.
GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services.
