Provider Correspondence Coordinator I

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 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.
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This is a full-time remote position.
 

Please fill out an application on our company page, linked below, to be considered for this position

​​​​​​https://j.brt.mv/jb.do?reqGK=27716755&refresh=true

Benefits:

• Medical, Dental, Pharmacy, and Vision Coverage 
• 401K
• FSA
• PTO and Paid Holidays

Schedule:

• Full time minimum 7.5 work days with 37.5 work week

Required Skills, Experience & Education:

1. High School education or equivalency.
2. 6 months - 2 years medical claims processing or customer service experience.
3. Strong reading, writing and verbal communication skills
4. Good analytical, problem solving, decision making and organizational skills.
5. 10 key proficiency of 105 spm net on a computer numeric keypad.
6. Type a minimum of 35 wpm net on a computer keyboard.
7. Ability to work under pressure and meet mandated time frames.
8. Ability to read and interpret contracts and apply Moda Health policies and procedures.
9. Ability to communicate positively, patiently, and courteously with callers.
10. Proficiency in Facets, Content Manager and EBT.
11. Proficiency in computer applications such as Word and Excel.
12. Ability to maintain confidentiality and project a professional business image.

Primary Functions:

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

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.

For more information regarding accommodations please direct your questions to HRAdmin@modahealth.com.
 

Salary : $18 - $21