Medical Claims Auditor I

Moda Health•Milwaukie, OR

13h•Remote

About The Position

Provides accurate quality assurance auditing of post-payment claims to determine correct adjudication and benefit application. Completes complex reports and provide feedback on accuracy. This is a FT WFH position. Pay Range $18.39 - $20.58 hourly, DOE. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. Please fill out an application on our company page, linked below, to be considered for this position. https://j.brt.mv/jb.do?reqGK=27778811&refresh=true

Requirements

High school diploma or equivalent.
6 months – 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
Strong reading, writing, and verbal communication skills.
Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities.
10-key proficiency on a computer numeric keypad.
Type a minimum of 25 wpm net on a numeric keyboard.
Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines.
Ability to maintain confidentiality and project a professional business image.
Ability to come into work on time and daily.
Proficiency in Facets claims processing applications and Benefit Tracker.
Computer proficiency in Microsoft office applications.

Nice To Haves

Knowledge of Business Objects and Employer Online Services is helpful.
Knowledge and understanding of Delta Dental’s administrative policies affecting claims and customer service.

Responsibilities

Audit claims daily using a statistically valid sampling method, and prescriber audit criteria.
Performs simple adjustments as necessary.
Conduct in-depth claims audits on performance groups, as well as focus audits for specifically identified situations on a scheduled basis.
Compiles and publishes reports based on the results of claim audits as well as processor productivity on a weekly, monthly, and quarterly basis.
Run report in Business Objects to conduct audits.
Prepares required monthly and/or quarterly reports for specific group performance guarantee, production, and accuracy results.
Identify trends from audit results and recommend improvements to increase overall quality.
Assists in the investigation and response to Market Conduct Examination inquiries.
Other duties as assigned