Milwaukie - OR Full Time 2 months ago

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.

Moda Health is searching for Dental Claims Processors who will review claims to determine the reason the claim did not auto-adjudicate. They will make corrections as necessary and process claims according to processing policies and contract provisions.

This position is currently full time work from home and is accepting candidates from OR, WA, TX, ID and AK.

Required Skills, Experience, & Education

  • High school diploma or equivalent.
  • 10-key proficiency of 105 kspm net on a computer numeric keypad.
  • Type a minimum of 35 wpm net on a computer keyboard.
  • Ability to achieve and maintain quality and quantity standards.
  • Possess legible hand writing.
  • Knowledge of dental terminology, and ADA codes, preferred.
  • Data Entry experience dealing with all types of plans/claims preferred.
  • Good reading, verbal and written communication skills. Ability to listen and communicate clearly and interact professionally, patiently and courteously with co-workers and supervisor.
  • Analytical, problem solving, and decision making skills. Detail oriented and good memory retention with ability to shift priorities.
  • Good organizational skills, ability to work well under pressure and ability to handle a variety of functions in order to meet timelines.
  • Ability to interpret contracts and apply MODA Policies and Procedures to claims processing.
  • Ability to come into work on time and on a daily basis.
  • Ability to maintain confidentiality and project a professional business image.

Primary Functions:

  • Use contract notes and a processing manual to apply correct group specific and standard contract benefits to process pended claims. Know benefits provided by specific plans, how to determine eligibility, how to determine if claims qualifies for benefits, how system should pay and how to enter information so correct benefits are paid.
  • Document in a clear and concise manner and analyze and interpret existing file notes and documentation.
  • Send clinical request and missing information letters.
  • Ability to perform some manual calculation of benefits.
  • Analyze pended claims to determine why the claim pended from auto-adjudication.
  • Other duties as assigned

Job Type: Fully Remote

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

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.

Please see above.

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