Medical Claims Processor I - Remote (Ak, Az, Fl Id, Or Wa)

Job Title
Medical Claims Processor I - Remote (AK, AZ, FL ID, OR WA)
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 Work From Home PST position is open to candidates living or willing to relocate to the following States; 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=27706684&refresh=true

Benefits

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

Schedule

• 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.
• PST

Requirements

• Analytical reasoning and flexibility
• High School diploma or equivalent
• 10-key proficiency of 135 spm
• Demonstrates work habits that include punctuality, organization, and flexibility
• Type a minimum of 35 wpm
• Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred
• Experience with Facets platform a plus
• Identify all the duties and responsibilities
• 6-12 months data entry or medical office experience preferred
• Ability to maintain balanced performance in areas of production and quality
• Professional and effective written and verbal communication skills

Primary Functions

• Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
• Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
• Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
• Adjudication of claims to achieve quality and production standards applicable to this position.
• Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
• 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.
• Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
• Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.

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
¤17.50 Hourly to ¤18.66 Hourly