Medical Claims Cob Processor Remote (Ak, Az, Fl, Id, Or, & Wa)

Job Title
Medical Claims COB Processor Remote (AK, AZ, FL, ID, OR, & WA)
Duration
Open Until Filled
Work From Home
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.
Investigates and processes COB (Coordination of Benefits) updates, COB claims, and COB related claim adjustments.
Performs File Reviews, issues refund requests and completes all necessary steps needed for claims processing, updates, and adjustments. Assists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete a COB claim or adjustment.This position is currently full time PST remote position for candidate living or willing to relocated to AK, AZ, FL, ID, OR or WA.
Follow the link below and complete an application for this position.

• Https://j.brt.mv/jb.do?reqGK=27708687&refresh=true

Benefits

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

Schedule

• PST

Required Skills, Experience & Education

• Ability to maintain balanced performance, which consistently exceeds minimum expectations in areas of production and quality.
• Type a minimum of 35 wpm net on a computer keyboard.
• Ability to maintain confidentiality internally and externally and project a professional business image always.
• Ability to multitask and work well under pressure and meet timelines.
• Good analytical, problem solving, decision making and detail-oriented skills with ability to shift priorities as needed.
• Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
• High School diploma or equivalent.
• Demonstrates work habits that include Moda Health standards of attendance and punctuality, as well as flexibility.
• Knowledge and understanding of Moda Health administrative policies affecting claims and customer service.
• 10-key proficiency of 135 spm net on a computer numeric keypad.
• Proficiency in claims processing systems
• Good organizational abilities and the ability to handle a variety of functions .
• Facets, Word, and Excel.
• Professional and effective written and verbal communication skills.

Primary Functions

• Thoroughly documents actions as required by internal procedure and market conduct guidelines.
• Prepares and sends refund requests, and other form letters.
• Assists internal departments with correcting eligibility and programming issues as needed.
• Performs basic and moderately complex claim adjustments into the system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
• Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, COB, and out of pocket, etc.
• Reviews User Procedure Manuals (UPMs) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
• Provides back up to Medical support and Medical Claims when requested.
• Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
• Review, analyze, and resolve claims through the utilization of available resources for complex claims.
• Release claims and adjustments by deadline to meet Company, state regulations, contractual agreements, and group performance guarantee standards.
• Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
• Adjudication and adjustment of claims to achieve quality and production standards applicable to this position.
• Perform other duties as assigned.
• Monitors and maintains unit inventory through adjustments, refunds, telephone calls and reports.
• Reviews Files and analyzes results and organizes multiple adjustments as needed.
• Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
• Responds and follows up using FACETS, Content Manager and E-mail.

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