Provider Correspond Coord I

About Moda

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. 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.

Job Summary

Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department. This position researches and provides written response to medical provider correspondence and appeals regarding claim edits, processing, authorizations and medical necessity reviews; researches and provides written response to medical inquiries regarding benefit and plan design issues. This is a FT WFH position.

Pay Range

$19.43 - $21.86 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.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Primary Functions

• Responds to provider appeals and related correspondence.
• Interacts with physician/provider offices by letter or phone to gather additional information regarding claim disputes.
• Performs a total claim review to determine over/underpayment on problem claims.
• Works with Claims Support to adjust previously processed claims.
• Documents accurately in Facets regarding outcome of claims disputes.
• Mets the departments established standards for case completion.
• Other duties as assigned.

Required Skills & Experience

• High School education or equivalency.
• 6 months - 2 years’ medical claims processing or customer service experience.
• Strong reading, writing and verbal communication skills
• Good analytical, problem solving, decision making and organizational skills.
• 10 key proficiency of 105 spm net on a computer numeric keypad.
• Type a minimum of 35 wpm net on a computer keyboard.
• Ability to work under pressure and meet mandated time frames.
• Ability to read and interpret contracts and apply Moda Health policies and procedures.
• Ability to communicate positively, patiently, and courteously with callers.
• Proficiency in Facets, Content Manager and EBT.
• Proficiency in computer applications such as Word and Excel.
• Ability to maintain confidentiality and project a professional business image.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
• Internally with Claims, Customer Service, Healthcare Services, Membership Accounting, Information Technology, and Professional Relations. Externally with Providers, Members, Vendors, and Insurance companies.