Inpatient Claims Processor I

Inpatient Claims Processor I - Remote

About Moda Health

Founded in Oregon in 1955, Moda Health is dedicated to building a better future for healthcare. We are committed to offering outstanding coverage to our members, compassionate support to our community, and comprehensive benefits to our employees. Moda values diversity and inclusion in our workplace and invites applications from candidates who share this commitment.

About the Role

Moda Health is seeking a motivated and detail-oriented Inpatient Claims Processor I to join our team. This is a full-time, permanent, remote position responsible for the timely and accurate payment of Commercial and Medicaid inpatient hospital claims. You will also be responsible for answering internal questions from various departments and responding to provider correspondence when necessary.

Key Responsibilities

• Review, process, and adjust Commercial and Medicaid inpatient claims.
• Interpret coding and medical terminology in relation to diagnoses and procedures.
• Price and resolve inpatient claims using available resources for moderate to complex claims, adjustments, and file reviews.
• Process claims for various contract types, including DRG, per diem, case rate, and % of CMS.
• Analyze and apply plan concepts such as deductibles, coinsurance, and copays.
• Examine claims to determine if further investigation is needed and route them appropriately.
• Contact providers and other external sources for additional information.
• Adjudicate claims to meet quality and production standards.
• Release claims by deadlines to comply with company, state, and contractual agreements.
• Review and adhere to Policy and Procedures for accurate and efficient claims processing, and suggest potential process improvements.
• Maintain a high degree of discretion and confidentiality in compliance with federal, state, and departmental guidelines.

Requirements

• High School diploma or equivalent.
• 1-2 years of medical claims processing experience.
• Proficiency with 10-key at 135 words per minute.
• Typing speed of at least 35 words per minute.
• Knowledge of medical terminology, CPT codes, and ICD-10 codes.
• Strong verbal, written, and interpersonal communication skills.
• Analytical, problem-solving, and organizational skills.
• Ability to work well under pressure.
• Ability to maintain confidentiality and project a professional image.
• Ability to maintain balanced performance in production and quality.

What We Offer

• Competitive hourly pay range: $21.30 - $23.96 (depending on experience).
• Medical, Dental, Vision, Pharmacy, Life, and Disability insurance.
• 401K with matching contributions.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• Paid Time Off (PTO) and Company Paid Holidays.

To Apply

Please visit our company page to fill out an application: https://j.brt.mv/jb.do?reqGK=27778909&refresh=true