Inpatient Claims Processor I

Remote

Responsibilities

Maintain confidentiality and project a professional business image
Review, process and adjust Commercial and Medicaid inpatient claims.
Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.
Review Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
Perform other duties as assigned.

High School diploma or equivalent.
10-key proficiency of 135 wpm.
Knowledge of medical terminology, CPT codes and ICD-10 codes.
Ability to work well under pressure.
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
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This is a FT WFH role. Pay Range
$21.30 - $23.96 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.
Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA
PTO and Company Paid Holidays Required Skills,
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.

https://j.brt.mv/jb.do?reqGK=27778909&refresh=true Benefits
For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality.
Today, like then, weâre 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.
Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims.
Answer internal questions from various departments and respond to correspondence from providers when necessary.
Please fill out an application on our company page, linked below, to be considered for this position.