Medical Claims Pricer I
Medical Claims Pricer I
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Job Description
Lets do great things together!
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were 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. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
Responsible for utilizing resources to efficiently review price and process medical claims with outside vendors. Handle complex file reviews related to network pricing.This is a FT WFH role.
Pay Range
$19.05 $21.43 hourly (depending on experience).
Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability
Required Skills Experience & Education:
- High School diploma or equivalent.
- 2 3 years medical/dental claim processing or customer service dealing with all types of plans/claims.
- Professional and effective written and verbal communication skills.
- Good analytical problem solving decision making and organizational and detailoriented skills with ability to shift priorities.
- 10key proficiency of 105 spm.
- Type a minimum of 45 wpm.
- Good organizational ability to work under pressure to handle variety of functions and meet timelines.
- Ability to maintain confidentiality and project a professional business image.
- Ability to come into work on time and on a daily basis.
- Proficient with Facets Word and Excel.
Primary Functions:
- Prices and processes medical claims with outside vendors including First Choice IPN Healthy Directions PHCSPPO and First Health.
- Work closely with Medical Professional Relations Customer Service and Support on pricing requests.
- Able to differentiate between all plan types when processing claims for multiple groups.
- Identify inconsistencies with network setups.
- Contacts outside vendors related to pricing and website issues.
- Review analyze and resolve claims through the utilization of available resources including P&Ps member handbooks provider contracts and EBT.
- Complete complex file reviews associated with network pricing.
- Handle claim adjustments related to network pricing.
- Assist with Member and Providers Appeals related with network pricing.
- 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 40 hours per week including evenings and occasional weekends to meet business need.
- Internally with Medical Claims Customer Service Support Medical Professional Relations. Externally with outside vendors.
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. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.
Employment Type
Full-Time
