What are the responsibilities and job description for the Medical Claims Pricer I position at Moda Health?
Let’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.
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. Let’s be better together.
Moda Health is seeking a Medical Claims Pricer to price medical claims with outside vendors.
Primary Functions:
- Prices and processes medical claims with outside vendors including First Choice, IPN, Healthy Directions, PHCS-PPO, and First Health.
- Work closely with Medical Professional Relations, Customer Service, and Support on pricing requests.
- Able to differentiate between all plan types when processing claims for multiple groups.
- Identify inconsistencies with network setups.
- Contacts outside vendors related to pricing and website issues.
- Review, analyze and resolve claims through the utilization of available resources including P&Ps, member handbooks, provider contracts, and EBT.
- Complete complex file reviews associated with network pricing.
- Handle claim adjustments related to network pricing.
- Assist with Member and Providers Appeals related with network pricing.
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.
