Dental Screen Auditor I

Moda Health•Milwaukie, OR

1d•Hybrid

About The Position

Moda Health is hiring a full-time hybrid Dental Screen Auditor I based in Milwaukie, Oregon. The role provides backup support to leads, including staff training, and handles complex file reviews, claims adjustments, and Coordination of Benefits (COB) claims. Work includes phone calls, overpayment recoveries, stop payments, void checks, report processing, member accumulator updates, deductible credits, and claim adjustments related to provider updates. The position processes and reviews dental claims for Medicare, Oregon Health Plan, commercial group, and individual plans in accordance with compliance requirements, contractual terms, administrative policies, and internal procedures. The auditor documents work clearly, interprets file notes and requests, communicates with members, providers, and other insurers, investigates COB claims, and performs basic and complex adjustments. Reviewing clinical information may involve interpreting diagnostic X-rays and dental terminology, making approval decisions, or referring claims to dental consultants. The role also conducts detailed claim-file reviews to identify overpayments or underpayments, supports claims processing and training teams, monitors manually tracked offsets for ASO prepay claims, assists with group audits, and responds to Customer Service tasks. The position reviews procedure manuals, identifies process trends, and recommends improvements. The work is performed in an office environment with extensive computer and keyboard use, frequent telephone communication, and a requirement for reliable high-speed wired internet to support hybrid or remote work. Work beyond the standard workweek, including evenings and occasional weekends, may be needed to meet business needs.

Requirements

High school diploma or equivalent.
10-key proficiency of 105 kspm net on a computer numeric keypad.
Typing speed of at least 25 wpm net on a computer keyboard.
Strong reading, writing, and verbal communication skills.
Ability to handle complex support functions accurately and on time.
Ability to back up all Claim Support functions and take on additional responsibilities while maintaining the current workload.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Analytical, problem-solving, organizational, and detail-orientation skills.
Ability to accurately track refunds and post them to the correct member, provider, and group accounts.
Ability to track and request appropriate funds to be reissued to members and providers.
Ability to review files, analyze results, and organize multiple adjustments or accumulator updates.
Ability to maintain balanced performance meeting production and quality expectations.
Ability to meet or exceed company attendance standards.
Reliable, high-speed, hard-wired internet connection for remote or hybrid work.
Comfort with being on camera for virtual training and meetings.

Responsibilities

Follow compliance rules while processing claims, requesting refunds, and issuing additional benefits for Medicare, Oregon Health Plan, commercial group, and individual plans.
Document claim work thoroughly and clearly, and analyze existing file notes and documentation.
Interpret requests from members, providers, and internal departments to ensure they comply with contractual and administrative guidelines.
Communicate by telephone with members, providers, and other insurance carriers.
Send custody, primary payment, refund request, and other form letters in a timely manner.
Perform basic and complex adjustments on previously processed claims using claims systems, workbaskets, attachments, emails, and reports.
Interpret diagnostic X-rays and dental terminology to review clinical claim information, make approval decisions, or refer claims to dental consultants.
Investigate and process COB claims in a timely manner and update information as required.
Review User Procedure Manuals and suggest process improvements.
Identify and refer system and procedure trends, recommending changes to improve efficiency and reduce errors.
Conduct detailed claims-file reviews to determine overpayments and underpayments.
Provide backup to claims processing, training units, leads, and other Claim Support functions as needed.
Respond to and follow up on Customer Service tasks and issues.
Monitor logs for manually tracked offsets on ASO prepay claims.
Assist with gathering data for group audits.
Track refunds and post them to the correct member, provider, and group accounts.
Track and request appropriate funds to be reissued to members and providers.
Review files, analyze results, and organize multiple adjustments or accumulator updates as needed.
Perform department reports, projects, and other assigned duties.