Remote Medical Claims Processor I

Moda Health; Portland (OR); On-site; USD 24,000 - 27,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

Employee Assistance Program

PTO and Company Paid Holidays

Job summary

Moda Health is seeking a full-time, work-from-home Medical Claims Data Entry professional in Oregon. The role focuses on accurate, timely entry and resolution of simple to moderately complex medical claims, with requirements for data entry speed, medical terminology knowledge, and adherence to policies.

Pay ranges from $17.34 to $19.41 per hour, DOE. Benefits include medical/dental/vision, 401K matching, FSA, EAP, PTO, and holidays.

Qualifications

• High School diploma or equivalent.
• 6–12 months data entry or medical office experience preferred.
• 10-key proficiency of 135 spm.
• Type a minimum of 35 wpm.
• Knowledge of medical terminology and CPT/ICD codes preferred.
• Punctual, organized, and flexible work habits.
• Ability to balance production and quality.
• Analytical reasoning and flexibility.
• Professional written and verbal communication.
• Experience with Facets platform a plus.
• Identify all duties and responsibilities.

Responsibilities

• Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
• Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
• Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
• Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
• Adjudication of claims to achieve quality and production standards applicable to this position.
• Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
• Reviews Policies and Procedures (P&P’S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
• Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
• Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs.
• Moda’s standard workweek is a 37.5 hour work week.
• Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.

Skills

Medical terminology

10-key 135 spm

Typing 35 wpm

Analytical reasoning

Communication skills

Data entry accuracy

Flexibility

Education

High School diploma or equivalent

Tools

Facets platform

Job description

Moda Health is seeking a full-time, work-from-home Medical Claims Data Entry professional in Oregon. The role focuses on accurate, timely entry and resolution of simple to moderately complex medical claims, with requirements for data entry speed, medical terminology knowledge, and adherence to policies.

Pay ranges from $17.34 to $19.41 per hour, DOE. Benefits include medical/dental/vision, 401K matching, FSA, EAP, PTO, and holidays.