Medical Claims Savings Coordinator I

Moda Health•Milwaukie, OR

1d•Remote

About The Position

Founded in Oregon in 1955, Moda is a company committed to quality and building a better future for healthcare by offering outstanding coverage to members, compassionate support to the community, and comprehensive benefits to employees. Moda values diversity and inclusion and aims to demonstrate this commitment through all business practices. The Medical Claims Savings Coordinator I position coordinates Change Healthcare TruClaim, Access Plus, and Bill Management services and provides support for Change Healthcare services. This is a full-time work-from-home role.

Requirements

High school education or equivalent.
2 years medical claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
Strong reading, writing and verbal communication skills to communicate positively, effectively, patiently, and courteously with other staff members, vendor, providers, and members.
Excellent analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities in a rapidly changing environment.
Must have the ability to work with frequent interruptions and demonstrate professional leadership.
Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
Ability to take initiative and be a self-starter.
Ability to perform project management.
10-key proficiency of 105 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Good organizational ability to work under pressure to handle variety of functions and meet timelines.
Maintain confidentiality and project a professional business presence and appearance.
Proficiency in Facets, Benefit Tracker, Content Manager.
Knowledge and understanding of Moda administrative policies.
Knowledge of medical billing and coding and/or the ability to learn & apply these concepts.
Proficiency with personal computers, Internet research, and software applications such as Excel, Word, and PowerPoint.

Nice To Haves

Knowledge of principles of clinical editing would be helpful.
Certified Professional Coder (CPC) designation would be helpful.

Responsibilities

Responsible for all aspects of Change Healthcare TruClaim and Repricing services including receiving, processing, and reporting data to and from vendors.
Review and apply established TruClaim edits to appropriate claims from the daily TruClaim Report.
Review and apply established Repricing amounts to appropriate claims from the daily Bill Management and Access Plus reports.
Generates weekly report of non-utilized TruClaim edits.
Provides suggestions to Clinical Policy & Reimbursement Analyst for needed customizations and/or ways to optimize use of TruClaim services.
Process Change Healthcare Credits/Refunds.
Review and assist with member and provider disputes and appeals.
Knowledge and understanding all plan types and Moda administrative policies affecting claims processing and adjustments.
Process vendor payments on a timely basis.
Act as a contact person for Change Healthcare TruClaim inquiries both internally and externally.
Provide back up for other Change Healthcare staff members.
Provide training as indicated by Supervisor.
Perform other duties as assigned