Dental Claims Processor I

Moda Health; Portland (OR); Hybrid; USD 24,000 - 25,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Pharmacy Benefits

Life Insurance

Disability Insurance

401K Matching

FSA

Employee Assistance Program

PTO & Holidays

Job summary

Moda Health in Milwaukie, Oregon is seeking a Pended Claims Processor to review claims and determine why auto-adjudication did not occur. You will correct as needed and process claims according to policies and contracts.

Hybrid work in Milwaukie, with pay range $17.34–$18.36 hourly depending on experience. Key functions include applying benefits, documenting clearly, issuing missing information letters, and performing some manual benefit calculations.

Qualifications

• 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 handwriting.
• 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 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.

Responsibilities

• 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 qualify 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

Skills

10-key proficiency

Typing 35 wpm

Strong communication

Analytical problem solving

Attention to detail

Confidentiality

Contract interpretation

Time management

Education

High school diploma or equivalent

Job description

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.

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

This is a hybrid position based in Milwaukie Oregon. Review claims to determine the reason the claim did not auto-adjudicate. Make corrections as necessary and process claims according to processing policies and contract provisions.

Pay Range

$17.34- $18.36 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.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

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 handwriting.
• 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 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 qualify 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

Working Conditions & Contact With Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with Imaging Services, Claim Support, and Professional Relations.

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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our [e-mail] email.