Provider Billing & Compliance Analyst

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Job Description:

If this opportunity aligns with your strengths, background, and commitment to fostering inclusivity, we encourage you to apply! At the Oregon Health Authority (OHA), we value diversity and encourage applicants from all backgrounds and experiences to help us build a stronger, more equitable future for all.

Opportunity Awaits, Apply Today! – Provider Billing & Compliance Analyst (Program Analyst 1) 4 positions

The Medicaid Division is responsible for the design, development, implementation, monitoring, evaluation, and improvement of publicly funded Medicaid programs and related health programs, including the Oregon Health Plan (OHP), Healthier Oregon, the OHP-Bridge Program, and initiatives under 1115 demonstration waivers, state plan authorities, and 1915 home and community-based services waivers. The Division defines and manages the Oregon Administrative Rules governing OHP-covered health care services, eligible fee-for-service providers, and participating managed care plans, including Coordinated Care Organizations (CCOs), to ensure programs and services are delivered effectively, equitably, and in compliance with state and federal regulations.

Provider Services supports healthcare providers by assisting with claims reviews, payment approvals, technical inquiries, and billing issues.

The Provider Billing and Compliance Team is responsible for resolving billing complaints submitted by Oregon Health Plan members by researching complex eligibility, provider enrollment, and claims issues; applying Oregon Administrative Rules (OARs), Code of Federal Regulations (CFRs), and agency policy; resolving discrepancies; guiding providers; and rendering formal compliance determinations. In this position, you will protect program integrity by ensuring billing practices are accurate, compliant, and consistently applied through individual case review and technical support.

In this position, you will have the privilege and responsibility of factoring in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.

For a full review of the position description, please click here.

What We Are Looking For

Minimum Qualifications: These qualifications must be reflected in your application for consideration.

A Bachelor's Degree in Business or Public Administration, Behavioral or Social Sciences, or a degree related to the agency program that demonstrates the capacity for the knowledge and skills; OR

Any combination of experience or education equivalent to three years technical-level experience that typically supports the knowledge and skill requirements listed for the classification.

Desired Attributes: The following are desired attributes that we have identified as key to success for this role at OHA. These are the attributes we are looking for in our top candidate. If you have any of these, please let us know in your application.

• Knowledge of health services delivery systems, particularly the Oregon Health Plan (OHP), Medicaid administration in Oregon, provider enrollment, healthcare claims processing, Coordinated Care Organizations (CCOs), and related health and social service systems.
• Knowledge of legislative and regulatory processes, including experience analyzing, interpreting, and applying federal and state Medicaid laws, regulations, policies, and program requirements; specific knowledge of Oregon Administrative Rules (OARs) and Oregon Revised Statutes (ORS) is valued.
• Preference may be given to candidates with knowledge of Medicaid Fee for Service billing and Coordinated Care Organizations (CCOs) and extensive experience working within complex healthcare systems, including researching and resolving multifaceted claims, billing, eligibility, enrollment, or compliance issues. Ideal candidates will also have experience providing technical assistance and collaborating with healthcare providers, managed care entities, and partner agencies to explain complex policies, procedures, and billing requirements while supporting consistent, accurate, and equitable program administration.
• Experience analyzing and synthesizing quantitative and qualitative information to identify trends, resolve complex issues, support operational decision-making, and improve program performance and compliance, including experience working with complex information systems and data.
• Experience fostering constructive and collaborative working relationships across teams and organizations while coordinating work, facilitating communication, and supporting continuous quality, process, or operational improvements.
• Strong oral and written communication skills across a variety of forums, including experience preparing reports, technical correspondence, presentations, and communicating complex qualitative and quantitative information in ways that are accessible, inclusive, culturally responsive, and appropriate for diverse audiences.
• Experience managing multiple priorities and complex workloads while maintaining accuracy, exercising sound judgment, and meeting established timelines in a fast-paced, highly regulated environment.

Preference Statement:  Preference may be given to candidates who possess the following job-related knowledge, skills, and abilities.

• Aligned with business need, one of the available positions will require bilingual proficiency, and preference may be given for the ability to read, write, and speak English and Spanish, or for one of these common languages in Oregon other than English (Chinese, Russian, Vietnamese) with full proficiency.

Application Guidance

Your candidate profile and application are your opportunity to showcase your skills and interest in this role. Submissions will be reviewed for clarity, consistency, and communication skills, and for alignment with the guidance provided in the below:

Submission Requirements:

• Resume – Attach your current resume that clearly outlines your education and work experience relevant to this position.
• Supplemental Questions – Answer all supplemental questions completely and accurately.
• Final Check! – Before submitting, confirm that all required materials are included, and your Workday Job History is current. The information in your application will be used to complete an Equal Pay Analysis to determine salary placement upon hire. Visit the Equal Pay Analysis Webpage for more information.

How to Apply:

• External Candidates:  Visit the State of Oregon job opportunities webpage or click the “Apply” tab above to submit your application, following all submission requirements.
• Internal Candidates: Current State of Oregon employees must apply through their employee Workday login, following all submission requirements.

After You Apply:

• Complete any pending tasks in Workday under “My Applications” prior to the application deadline.
• Check your email (including junk folder) and Workday inbox regularly for updates on your application.

Reminders:

• Eligible veterans and Oregon National Guard servicemembers (current and former) who meet the qualifications of the position will be awarded candidate preference. To protect your information and ensure correct processing, please follow the instructions for submitting your Veterans’ Preference documentation.
• Please download and save a copy of this job announcement and linked position description, as it is not available after the application deadline.

About the Team & Benefits of Joining

We offer a workplace that balances productivity with enjoyment; promote an atmosphere of mutual respect, dedication, and enthusiasm. You will collaborate with a team of bright individuals to work with and learn from.

If you're driven by the passion to do something meaningful that changes lives, the Oregon Health Authority is the place for you. We also offer a competitive benefits package including:

• Excellent, low-cost medical, vision, and dental coverage for you and your family.
• Optional benefits like life insurance, disability coverage, deferred compensation, and FSA options for health and childcare.
• Generous paid time off: 11 holidays, 3 personal days, monthly sick leave, and vacation accrual starting at 8 hours/month.
• Potential eligibility for the Public Service Loan Forgiveness Program.
• Retirement security through Public Employees Retirement System (PERS)/Oregon Public Service Retirement Plan (OPSRP).
• Training and development opportunities to grow your career with the State of Oregon.

Additional Details

• This announcement is for 4, full-time, permanent, SEIU represented, Provider Billing & Compliance Analyst (Program Analyst 1) positions based in Salem, Oregon.
• These are hybrid (5% in-office) positions. “Review Section 4: Working Conditions” in the position description (linked above) for more information.
• Employment is contingent upon a criminal records check and a driving records check that meets OHA criteria at the time of hire and throughout employment.
• The salary listed is the non-PERS qualifying range. If the successful candidate qualifies for PERS, the salary range will increase by 6.95%. For more information, see the Classification and Compensation page.
• The State of Oregon does not request or require your age, date of birth, attendance or graduation dates from an education institution during the application process.
• This position does not provide visa sponsorship. Within three days of hire, you will be required to complete I-9 documentation and confirm authorization to work in the United States. OHA will use E-Verify to verify work authorization. If your employment eligibility depends on sponsorship now or in the future, you will not meet the requirements for this position.
• We evaluate candidates based on their own skills and experience. Unless explicitly approved, outside resources – including Artificial Intelligence (AI) tools – are not permitted during assessments or interviews. Use of unauthorized resources will disqualify a candidate from further consideration.

Contact Information
Recruiter: Stephanie Mitchell
Email: stephanie.d.mitchell@oha.oregon.gov
Phone (text friendly): (503) 979-7679

Accommodation Requests (ADA): OHA provides reasonable accommodations under the ADA, which may include alternative formats of materials or language support. If you need an accommodation to apply for this position or participate in the selection process, please contact the recruiter listed above.

Helpful Links & Resources

How to Set Job Alerts | Workday Applicant FAQ | Oregon Health Authority | Facebook | Instagram | LinkedIn | Veterans Resources | What You Need to Know to Get the Job

The Oregon Health Authority is an affirmative action and equal opportunity employer, committed to fair employment practices and pay equity for all employees. We do not discriminate based on protected class – including race, sex, veteran status, disability, age, color, religion, national origin, marital status, or sexual orientation – and does not screen applicants based on current or past compensation. Salary is determined through a fair review of your education, experience, and training as it relates to the position.

OHA is an anti-racist organization working to eliminate health inequities and dismantle structural barriers that impact underserved communities. Join us in advancing our Strategic Plan and building a more equitable Oregon.