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Medical, Prescription, and Dental Claims Auditor

Active
State & Local

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

General Info

Agency

Oregon → Multnomah CountyView Agency

NAICS

541211 - Offices of Certified Public AccountantsView NAICS

Place of Performance

Not specified

Set-Aside

NONE

Documents

This scope was carved out of RFP-12-2027.

The full solicitation package (1 document), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

Medical Claims Audit

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Organization & Contact Information

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AgencyOregon → Multnomah County
ContactsNo contacts available
OfficeN/A
Organization / Agency
Oregon → Multnomah County
View Agency Profile
Office AddressN/A
ContactsNo contact information available

Full Description

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Performs comprehensive audits of self-funded health plans for prime contractors on Multnomah County medical claims audit projects. Conducts medical, prescription, and dental claims audits and operational assessments to verify compliance with plan documents and identify cost recovery opportunities. Utilizes encrypted systems for sensitive health data. Requires mandatory HIPAA compliance. Delivers audit reports and staff training sessions.

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Same NAICS industry code

More opportunities from Oregon → Multnomah County

Same awarding agency

NAICS: 524292
SLED
Medical Claims Audit
Solicitation # RFP-12-2027
Multnomah County is seeking a qualified independent contractor to perform comprehensive medical, prescription, and dental claims audits and operational assessments for its self-funded health plans. The primary goals of this engagement are to ensure fiscal accountability, verify compliance with plan documents, and identify opportunities for cost recovery and process improvement. The selected vendor will be responsible for conducting audits at the County's discretion, implementing robust quality assurance and error-checking protocols, and providing a knowledge transfer plan, including training sessions for County staff. The contract may have a term of up to five years, with payment terms set at Net 30. Proposals are due by September 23, 2026, via the Multco Marketplace Supplier Portal. Evaluation is based on cost, expertise, methodology, innovation, and alignment with County needs, with a specific emphasis on responsible business practices, including energy conservation and living wage standards. High priority is placed on HIPAA compliance for data security and the integration of equity-focused principles to identify health plan disparities. The County strongly encourages participation from minority-owned, women-owned, and emerging small businesses. Award will be granted to the responsible proposer whose proposal is deemed most advantageous, with the highest-scoring responsive bidder entering negotiations for final contract terms.
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

POSTED

16 days ago

DEADLINE

in 17 days
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