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Posted 2 weeks, 2 days ago

Moda Health

Inpatient Claims Processor I

Apply View on Remote OK

Roles

Inpatient Claims Processor I

Compensation

USD 21 - 23

Pay range $21.30 - $23.96 hourly (depending on experience); 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
Location basis
Actual pay based on qualifications

Benefits

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

Location

Portland

Work setup

Employment
full-time
Level
Mid-level
Remote policy
Source indicates Remote OK and work arrangement is Remote; position is FT WFH (work from home). Office environment described for close PC/keyboard/phone work.
Remote scope
unclear

Role details

Responsibilities

  • Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims
  • Answer internal questions from various departments
  • Respond to correspondence from providers when necessary
  • Review, process and adjust Commercial and Medicaid inpatient claims
  • Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures
  • Review, analyze, price, and resolve inpatient claims for moderate to complex inpatient claims, adjustments, and file reviews
  • Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS)
  • Analyze and apply plan concepts to claims (deductible, coinsurance, copay, out of pocket, etc.)
  • Examine claims to determine if further investigation is needed and route claims appropriately through the system
  • Contact providers and other outside sources for additional information
  • Adjudicate claims to achieve quality and production standards
  • Release claims by deadlines to meet company/state regulations and contractual agreements
  • Review Policy and Procedures (P&P) for process instructions and suggest process improvements
  • Perform job functions with a high degree of discretion and confidentiality
  • Perform other duties as assigned

Requirements

  • High School diploma or equivalent
  • 1-2 years medical claims processing experience
  • 10-key proficiency of 135 wpm
  • Type a minimum of 35 wpm
  • Knowledge of medical terminology, CPT codes and ICD-10 codes
  • Strong verbal, written, and interpersonal communication skills
  • Analytical, problem solving and organizational skills
  • Ability to work well under pressure
  • Maintain confidentiality and project a professional business image
  • Ability to maintain balanced performance in areas of production and quality

Application

Please fill out an application on our company page, linked below, to be considered for this position. Please mention the word ENJOYABLY and tag RODguMTk4Ljk5LjE0Mw== when applying to show you read the job post completely (#RODguMTk4Ljk5LjE0Mw==).

Portfolio
not required
GitHub
not required
Cover letter
not required
Apply flow
external

Company context

Building a better future for healthcare; offering outstanding coverage to members, compassionate support to the community, and comprehensive benefits to employees.

Product
Healthcare coverage and related employee benefits; inpatient hospital claims processing
Industry
Healthcare
HQ
Oregon

Contact

Kristy Nehler, Danielle Baker

humanresources@modahealth.com

Description

Let’s do great things, together! About Moda Position Summary Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims. Answer internal questions from various departments and respond to correspondence from providers when necessary. This is a FT WFH role. Primary Functions Review, process and adjust Commercial and Medicaid inpatient claims. Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures. Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews. Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS). Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc. Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system. Contact providers and other outside sources for additional information. Adjudicate claims to achieve quality and production standards applicable to the position. Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards. Review Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements. Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines. Perform other duties as assigned. Working Conditions & Contact With Others Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need. Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.

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