Remote Medical Claims Auditor I

Moda Partners, Inc.; Oregon; Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K matching

FSA

Employee Assistance Program

PTO and company holidays

Job summary

Moda Health is seeking a Quality Assurance Auditor to perform accurate post-payment claims audits and generate detailed reports. This full-time, remote position requires experience in claim processing, strong communication, and proficiency with Facets and Benefit Tracker.

Responsibilities include conducting audits, producing weekly and monthly performance reports, and identifying quality improvements. Remote work with potential for varied shifts is provided along with comprehensive benefits and

Qualifications

• High school diploma or equivalent required.
• 6 months to 2 years in claim processing or customer service.
• Strong reading, writing, and verbal communication skills.
• Analytical, problem solving, and detail-oriented with ability to shift priorities.
• Proficiency in Facets claims processing applications and Benefit Tracker.
• Familiarity with MS Office applications.

Responsibilities

• Audit claims daily using prescriber audit criteria and perform simple adjustments.
• Conduct in-depth claims audits for performance groups and focus audits as scheduled.
• Compile and publish weekly, monthly, and quarterly audit reports.
• Run PBIRS reports for audits and accuracy tracking.
• Prepare monthly/quarterly performance reports and identify trends to improve quality.
• Support investigations and respond to performance inquiries.
• Other duties as assigned.

Skills

Reading and writing skills

Verbal communication

10-key proficiency

Typing speed 25 wpm

Organizational and detail-oriented

Education

High school diploma or equivalent

Tools

Facets claims processing

Benefit Tracker

Employer Online Services

Microsoft Office

Job description

Moda Health is seeking a Quality Assurance Auditor to perform accurate post-payment claims audits and generate detailed reports. This full-time, remote position requires experience in claim processing, strong communication, and proficiency with Facets and Benefit Tracker.

Responsibilities include conducting audits, producing weekly and monthly performance reports, and identifying quality improvements. Remote work with potential for varied shifts is provided along with comprehensive benefits and