Medical Claims Processor I

　　Job Title

　　Medical Claims Processor I

　　Duration

　　Open Until Filled

　　Work Remote

　　Yes

　　Description

　　Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderate complexity medical claims in accordance with policies, procedures, and guidelines as outlined by the company. This is a Remote position.

　　Follow the link below and complete an application for this position.

　　https://j.brt.mv/jb.do?reqGK=27725180&refresh=trueBenefits:

　　Medical, Dental, Pharmacy Life & Disability

　　401K - Matching

　　FSA

　　Employee Assistance Program

　　PTO and paid holidays

　　Schedule:

　　PST schedule. Moda’s standard workweek is a 37.5 hour work week.Requirements:

　　High School diploma or equivalent

　　6-12 months data entry or medical office experience preferred

　　10-key proficiency of 135 spm

　　Type a minimum of 35 wpm

　　Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred

　　Demonstrates work habits that include punctuality, organization, and flexibility

　　Ability to maintain balanced performance in areas of production and quality

　　Analytical reasoning and flexibility

　　Professional and effective written and verbal communication skills

　　Experience with Facets platform a plus

　　Identify all the duties and responsibilities

　　Primary Functions:

　　Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.

　　Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.

　　Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.

　　Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.

　　Adjudication of claims to achieve quality and production standards applicable to this position.

　　Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.

　　Reviews Policies and Procedures (P&P’S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.

　　Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.

　　Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda’s standard workweek is a 37.5 hour work week.

　　Together, we can be more. We can be better. Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.

　　Pay Range

　　$17.00 Hourly to $20.38 Hourly