Inpatient Claims Processor I

Moda Health•Milwaukie, OR

9d•Remote

About The Position

Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims. Answer internal questions from various departments and respond to correspondence from providers when necessary. This is a FT WFH role.

Requirements

High School diploma or equivalent.
1-2 years medical claims processing experience.
10-key proficiency of 135 wpm.
Type a minimum of 35 wpm.
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.
Maintain confidentiality and project a professional business image
Ability to maintain balanced performance in areas of production and quality.

Responsibilities

Review, process and adjust Commercial and Medicaid inpatient claims.
Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS).
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
Contact providers and other outside sources for additional information.
Adjudicate claims to achieve quality and production standards applicable to the position.
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.
Review Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
Perform other duties as assigned.