Medical Claims Entry Operator at Moda Health in Milwaukie, OR

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 Enters the processing system all claims received by mail or route claims as directed to processing specific data entry queues. Interrogates data on claims received electronically where member or provider information does not match Moda records. This is a FT WFH role.

Pay Range $17.34 - $18.92 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.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27782855&refresh=true

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.
• Six months data entry experience.
• 10-key proficiency of 135 spm net on a computer numeric keypad.
• Typing ability of 35 wpm net.
• Proficiency with Microsoft Office applications and an understanding of basic claims processing rules.
• Strong problem solving and detail orientation skills.
• Medical terminology helpful.
• Ability to adapt to frequent changes in instructions.
• Ability to come into work on time and on a daily basis.
• Maintain confidentiality and project a professional business image.

Primary Functions:

• Data enters claims accurately using Moda computer systems. Reassigns claims appropriately as outlined by Medical Claims processing guidelines.
• Resolves claims that pend with errors in the processing system by matching claims received to Moda providers or member records.
• Research and problem solve basic claims data.
• Identifies and communicates trends.
• Performs other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.
• Internally with Membership Accounting, Medical Claims, 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 and Danielle Baker via our humanresources@modahealth.com email.