Dental Claims Auditor- Remote (Ak, Az, Fl, Id, Or, & Wa)

Job Title
Dental Claims Auditor- Remote (AK, AZ, FL, ID, OR, & WA)
Duration
Open until filled
Work From Home
Yes
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.
Please Follow The Link Below To Apply To This Position
The Dental Claims Processor Review claims to determine the reason the claim did not auto-adjudicate. Make corrections as necessary and process claims according to processing policies and contract provisions.This is a Remote PST position. We are only offering this position to candidates living in or willing to relocate to AK, AZ, ID, OR or WA.

• Https://j.brt.mv/jb.do?reqGK=27708824&refresh=true

Benefits

• Employee Assistance Program
• Medical, Dental, Vision, Pharmacy, Life, & Disability
• PTO and Company Paid Holidays
• 401K- Matching
• FSA

Schedule

• 2/3 days in the office located:10505 SE 17th Ave, Milwaukie, OR 97222
• PST

Required Skills, Experience & Education

• Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines.
• Type a minimum of 25 wpm net on a numeric keyboard.
• 10-key proficiency on a computer numeric keypad.
• Ability to maintain confidentiality and project a professionalism at all times.
• Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities.
• Strong reading, writing, and verbal communication skills.
• Knowledge and understanding of Delta Dental’s administrative policies affecting claims and customer service.
• High school diploma or equivalent.
• Knowledge of Power BI Report Server (PBIRS) is helpful.
• 6 months – 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
• Ability to start work on time and daily.
• Proficiency in Facets claims processing applications and Benefit Tracker.
• Computer proficiency in Microsoft office applications.

Primary Functions

• Run reports in Power BI Report Server (PBIRS) to conduct audits.
• Other duties as assigned
• Conduct in-depth claims audits on performance groups, as well as focus audits for specifically identified situations on a scheduled basis.
• Identify trends from audit results and recommend improvements to increase overall quality.
• Audit claims daily statistically valid sampling method, using prescriber audit criteria. Performs simple adjustments as necessary.
• Compiles and publishes reports based on the results of claim audits as well as processor productivity on a weekly, monthly, and quarterly basis.
• Prepares required monthly and/or quarterly reports for specific group performance guarantee, production, and accuracy results.
• Assists in the investigation and response to Market Conduct Examination inquiries.

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 ¤19.79 Hourly