Dental Claims Processor I
Dental Claims Processor 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
Review claims to determine the reason the claim did not autoadjudicate. Make corrections as necessary and process claims according to processing policies and contract provisions. This is a hybrid position based in Milwaukie Oregon.
Pay Range
$17.00 $18.00 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.
- 10key proficiency of 105 kspm net on a computer numeric keypad.
- Type a minimum of 35 wpm net on a computer keyboard.
- Ability to achieve and maintain quality and quantity standards.
- Possess legible handwriting.
- Knowledge of dental terminology and ADA codes preferred.
- Data Entry experience dealing with all types of plans/claims preferred.
- Good reading verbal and written communication skills. Ability to listen and communicate clearly and interact professionally patiently and courteously with coworkers and supervisor.
- Analytical problem solving and decisionmaking skills. Detail oriented and good memory retention with ability to shift priorities.
- Good organizational skills ability to work well under pressure and ability to handle a variety of functions to meet timelines.
- Ability to interpret contracts and apply MODA Policies and Procedures to claims processing.
- Ability to come into work on time and on a daily basis.
- Ability to maintain confidentiality and project a professional business image.
Primary Functions:
- Use contract notes and a processing manual to apply correct group specific and standard contract benefits to process pended claims. Know benefits provided by specific plans how to determine eligibility how to determine if claims qualify for benefits how system should pay and how to enter information so correct benefits are paid.
- Document in a clear and concise manner and analyze and interpret existing file notes and documentation.
- Send clinical request and missing information letters.
- Ability to perform some manual calculation of benefits.
- Analyze pended claims to determine why the claim pended from autoadjudication.
- Other duties as assigned
Working Conditions &Contact with Others
- Internally with Imaging Services Claim Support and Professional Relations
- Extensive close work constant sitting and extensive work. Work in excess of standard work week as need to meet business need.
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
