Appeal Intake Coordinator

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
This position performs clerical support for the Appeal Department. This includes identifying appeal and complaint types via mail fax and email. The appeal intake coordinator will create case records and assign tasks to coordinate and expedite the appeals workload. Other miscellaneous functions as requested by supervisor. 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:

1. High School Diploma or equivalent.
2. At least 6 months office experience.
   • One year of office experience preferred.
   • Professional experience in a healthcare setting preferred.
3. Ability to learn healthcare terminology and diagnostic codes.
   • Current knowledge of healthcare terminology and diagnostic codes is preferred.
4. Typing ability of 30 wpm net.
5. 10 key proficiency of 105 kspm on a numeric keypad.
6. Proficient with Microsoft Office applications.
7. Strong analytical and organizational skills. Strong detail orientation.
8. Strong verbal written and interpersonal communication skills.
9. Ability to work well under pressure work with frequent interruptions and shifting priorities.
10. Maintain confidentiality and project a professional business image.
11. Ability to adhere to Moda Health attendance policies and work assigned schedule which may include some overtime.

Primary Functions:

1. Sort and scan incoming member and provider appeals and complaints.
2. Review and assess incoming cases to accurately identify and categorize cases as needed.
3. Data enter appeals and complaints into Facets to create the appeal ID for assignment.
4. Responsible for sending case acknowledgement letters when necessary.
5. Assign new work based on appeal type.
   • Maintain a balanced and equitable workload for Appeal Coordinators to the extent possible.
   • Monitor caseload assignments and adjust as required.
6. Obtain additional or missing information for cases via fax or phone as needed.
   
   • May require contact with members providers and providers offices
7. Identifies and communicates trends.
8. Other duties as assigned.

Working Conditions &Contact with Others

• Office environment with extensive close PC and keyboard work constant sitting. Must be able to navigate multiple screens. Constant shifting of priorities and daytoday duties. Work in excess of 37.5 hours per week in order to meet business needs.
• Inside the company with own Member and Provider Appeals teams. Outside the company to obtain additional or missing information with Members Provider Offices and contracted 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.