Dental Claims Auditor I
Dental Claims Auditor I
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
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
Provides accurate quality assurance auditing of postpayment claims to determine correct adjudication and benefit application. Completes complex reports and provide feedback on is a FT WFH role.
Pay Range
$18.03 $20.18 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.
- 6 months 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
- Strong reading writing and verbal communication skills.
- Good analytical problem solving decision making organizational and detailoriented skills with ability to shift priorities.
- 10key proficiency on a computer numeric keypad.
- Type a minimum of 25 wpm net on a numeric keyboard.
- Good organizational skills ability to work well under pressure and ability to handle a variety of functions to meet timelines.
- Ability to maintain confidentiality and project a professional business image.
- Ability to come into work on time and daily.
- Proficiency in Facets claims processing applications and Benefit Tracker.
- Knowledge of Business Objects and Employer Online Services is helpful.
- Knowledge and understanding of Delta Dentals administrative policies affecting claims and customer service.
- Computer proficiency in Microsoft office applications.
Primary Functions:
- Audit claims daily using a statistically valid sampling method and prescriber audit criteria. Performs simple adjustments as necessary.
- Conduct indepth claims audits on performance groups as well as focus audits for specifically identified situations on a scheduled basis.
- Compiles and publishes reports based on the results of claim audits as well as processor productivity on a weekly monthly and quarterly basis.
- Run report in Business Objects to conduct audits.
- Prepares required monthly and/or quarterly reports for specific group performance guarantee production and accuracy results.
- Identify trends from audit results and recommend improvements to increase overall quality.
- Assists in the investigation and response to Market Conduct Examination inquiries.
- 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 standard work week including evenings and occasional weekends to meet business need.
- Internally with Claims Sales & Account Services Membership Accounting Benefit Configuration Information Services Customer Service and Provider Relations.
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
