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Roles
Compensation
USD 17 - 19
Pay range $17.34 - $19.41 hourly (DOE). Actual pay based on qualifications. Benefits include medical, dental, vision, pharmacy, life, disability, 401K matching, FSA, Employee Assistance Program, PTO and company paid holidays.
- Salary period
- hourly
Benefits
- Medical
- Dental
- Vision
- Pharmacy
- Life
- Disability
- 401K Matching
- FSA
- Employee Assistance Program
- PTO
- Company Paid Holidays
Tech stack
Nice to have
Location
Portland
Work setup
- Employment
- full-time
- Level
- Junior
- Remote policy
- Remote work (FT WFH). Flexible schedule may include working 5 hours of overtime on pre-determined Saturdays. Standard workweek is 37.5 hours.
- Remote scope
- unclear
Role details
Responsibilities
- Enter claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
- Review, analyze, and resolve claims for moderately complex claims using available resources.
- Analyze and apply plan concepts to claims including deductible, coinsurance, copay, and out of pocket.
- Examine claims to determine if further investigation is needed from other departments and route claims appropriately through the system.
- Adjudicate claims to achieve quality and production standards applicable to the position.
- Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
- Review policies and procedures (P&P) for process instructions to ensure accurate and efficient claims processing and suggest potential process improvements.
- Perform job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
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.
- Work habits including punctuality, organization, and flexibility.
- Ability to maintain balanced performance in production and quality.
- Analytical reasoning and flexibility.
- Professional and effective written and verbal communication skills.
- Experience with Facets platform is a plus.
Application
Please fill out an application on our company page, linked below, to be considered for this position. When applying, mention the word RECOMEND and tag RODguMTk4Ljk5LjE0Mw==.
- Portfolio
- not required
- GitHub
- not required
- Cover letter
- unclear
- Apply flow
- external
Company context
Building a better future for healthcare by offering outstanding coverage, compassionate support to the community, and comprehensive benefits to employees.
- Product
- health insurance / healthcare coverage
- Industry
- healthcare
- HQ
- Oregon
Contact
Kristy Nehler, Danielle Baker
humanresources@modahealth.com
Description
Let’s do great things, together! Moda is seeking a Medical Claims Processor I responsible for utilizing resources efficiently for accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines. This is a FT WFH (work from home) role. Review claims, interpret coding/medical terminology, analyze plan concepts (deductible, coinsurance, copay, out of pocket), route claims appropriately, release claims by deadlines to meet standards, review policies and procedures, and perform duties with discretion and confidentiality. Flexible schedule may include working 5 hours of overtime on pre-determined Saturdays; standard workweek is 37.5 hours.
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