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Medical Claims ProcessorJob TitleMedical Claims ProcessorDurationOpen Until FilledLocationBend,OR97702Other LocationJob Class: 105.6DescriptionLet’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re 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. We are currently seeking a Medical Claims Processor. As a Medical Claims Processor you will be responsible for the accurate and timely entry, review, and resolution of simple to moderate complexity medical claims in accordance with policies, procedures, and guidelines as outlined by company.Position Requirements:1. Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.2. Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims. 3. Analyze and apply plan concepts to claims that include: deductible, coinsurance, copay, out of pocket, etc.4. Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system. 5. Adjudication of claims to achieve quality and production standards applicable to this position.6. Release claims by deadline to meet Company, state regulations, contractual agreements and group performance guarantee standards.7. Reviews User Procedure Manuals (UPMs) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.8. Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state and departmental confidentiality guidelines.Are you ready to be a betterist? If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible. 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.Required Skills
High School diploma or equivalent.
6 – 12 months data entry or medical office experience preferred.
Typing proficiency of 35wpm and 10key proficiency of 135spm on a computer keyboard.
Knowledge of medical terminology, CPT codes and ICD-9 codes preferred.
Demonstrated work habits that include punctuality, organization, and flexibility.
Ability to maintain balanced performance in areas of production and quality.
Prior experience within a Facets platform a plus.
Ability to maintain confidentiality and project a professional business image.
