Medical Claims Pricer I

Moda Health•Milwaukie, OR

20d•$19 - $21•Remote

About The Position

Let’s do great things, together! About Moda 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. Position Summary Responsible for utilizing resources to efficiently review, price and process medical claims with outside vendors. Handle complex file reviews related to network pricing. This is a FT WFH role. Pay Range $19.05 - $21.43 hourly (depending on experience). 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=27765064&refresh=true Benefits : Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays

Requirements

High School diploma or equivalent.
2 – 3 years medical/dental claim processing or customer service dealing with all types of plans/claims.
Professional and effective written and verbal communication skills.
Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities.
10-key proficiency of 105 spm.
Type a minimum of 45 wpm.
Good organizational ability to work under pressure to handle variety of functions and meet timelines.
Ability to maintain confidentiality and project a professional business image.
Ability to come into work on time and on a daily basis.
Proficient with Facets, Word, and Excel.

Responsibilities

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.
Other duties as assigned