other
Posted YesterdayInpatient Claims Processor I
at Moda Health
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.
Requirements
- 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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Experience
- 1-2 years medical claims processing experience.
Benefits
- 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