Job Description

Let\'s do great things, together

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.

Job Summary:
Process claims and provide support related to Change Healthcare and Zelis services.

This is a Remote position for INTERNAL APPLICANTS ONLY.

Benefits:

• Medical, Dental, Pharmacy and vision coverage
• 401K
• FSA
• PTO and paid holidays

Schedule:

• PST

Requirements: * High school education or equivalent.

• 2 years of experience in medical claims processing or customer service, dealing with all types of plans/claims, and consistently exceeding performance levels.
• Strong reading, writing, and verbal communication skills to communicate positively, effectively, patiently, and courteously with other staff members, vendor, and providers.
• Excellent analytical, problem solving, and decision-making skills.
• Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player.
• Ability to take initiative and be a self-starter.
• Ability to track and coordinate projects and project activities.
• 10-key proficiency of 105 spm net on a computer numeric keypad.
• Type a minimum of 40 wpm net on a computer keyboard.
• Ability to adapt and follow through on multiple deliverables simultaneously, in a high-pressure environment.
• 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.
• Knowledge of principles of clinical editing preferred.
• Certified Professional Coder (CPC) designation preferred but not required.

Primary Functions: * 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 Zelis Drilldown report recommendations.
• 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, Zelis, and Macro Health Vendor Payments and Refunds.
• Review and assist with member and provider disputes and appeals.
• Knowledge and understanding of all plan types and Moda administrative policies affecting claims processing and adjustments.
• Knowledge and understanding of primary and Travel networks including Aetna, First Choice, First Health, PHCS Healthy Directions, PHCS PPO.
• Back-up for processing primary and Travel network claims, adjustments, and CSTs.
• Process vendor payments in a timely manner.
• Process adjustments and CSTs in a timely manner.
• Act as a contact person for Change Healthcare TruClaim, and Repricing inquiries both internally and externally.
• Provide back up for other team members.
• Provide training as indicated by Supervisor.
• Perform other duties and responsibilities as assigned.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.

Pay Range

\xc2\xa418.32 Hourly to \xc2\xa420.95 Hourly

Moda Health