Provider Correspond Coord I

Moda Health•Milwaukie, OR

6h•Remote

About The Position

Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department. This position researches and provides written response to medical provider correspondence and appeals regarding claim edits, processing, authorizations and medical necessity reviews; researches and provides written response to medical inquiries regarding benefit and plan design issues. This is a FT WFH position.

Requirements

High School education or equivalency.
6 months - 2 years’ medical claims processing or customer service experience.
Strong reading, writing and verbal communication skills
Good analytical, problem solving, decision making and organizational skills.
10 key proficiency of 105 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Ability to work under pressure and meet mandated time frames.
Ability to read and interpret contracts and apply Moda Health policies and procedures.
Ability to communicate positively, patiently, and courteously with callers.
Proficiency in Facets, Content Manager and EBT.
Proficiency in computer applications such as Word and Excel.
Ability to maintain confidentiality and project a professional business image.

Responsibilities

Responds to provider appeals and related correspondence.
Interacts with physician/provider offices by letter or phone to gather additional information regarding claim disputes.
Performs a total claim review to determine over/underpayment on problem claims.
Works with Claims Support to adjust previously processed claims.
Documents accurately in Facets regarding outcome of claims disputes.
Meets the departments established standards for case completion.
Other duties as assigned.