Provider Correspondence & Claims Support (Remote)

Moda Health; Portland (OR); On-site; USD 27,000 - 30,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401K matching

FSA

Employee Assistance Program

PTO and holidays

Job summary

Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department in Portland, OR, to research and respond to provider correspondence, appeals, and benefit inquiries. This FT WFH role supports remote operations and involves claim reviews, data entry, and adherence to timelines.

Responsibilities include gathering information, communicating with providers, and ensuring accurate documentation in Facets.

Qualifications

• 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.

Skills

Reading and writing

Verbal communication

Analytical skills

10-key 105 spm

35 wpm typing

Office software

Problem solving

Education

High School or equivalent

Tools

Facets

Content Manager

EBT

Word

Excel

Job description

Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department in Portland, OR, to research and respond to provider correspondence, appeals, and benefit inquiries. This FT WFH role supports remote operations and involves claim reviews, data entry, and adherence to timelines.

Responsibilities include gathering information, communicating with providers, and ensuring accurate documentation in Facets.