Provider Correspond Coord I
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At a glance
Job overview
Moda Health is hiring a Provider Correspond Coord I. Moda Health seeks a Provider Correspondence Coordinator to research and respond to medical provider correspondence and appeals, handling claim edits, authorizations, and benefit inquiries. The full‑time work‑from‑home role involves detailed claim reviews, interaction with providers, and documentation in Facets while meeting departmental standards.
Key focus areas include Respond to provider appeals and related correspondence, Interact with physician/provider offices by letter or phone to gather additional information regarding claim disputes, and Perform a total claim review to determine over/underpayment on problem claims.
Successful candidates bring High School Education Or Equivalency, 6 Months - 2 Years Medical Claims Processing Or Customer Service Experience, and 10 Key Proficiency Of 105 Spm Net On A Computer Numeric Keypad. Important skills include Reading, Writing, Communication, Analytical Skills, Problem Solving, and Decision Making.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Provider Correspond Coord I
Job Title
Provider Correspond Coord I
Duration
Open until filled
Description
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.
Job Summary:
Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department. This position researches and provides written response to medical provider correspondence and appeals regarding claim edits, processing, authorizations and medical necessity reviews; researches and provides written response to medical inquiries regarding benefit and plan design issues. This is a FT WFH position.
Pay Range
$19.43 - $21.86 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=27778789&refresh=true
Benefits:
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Medical, Dental, Vision, Pharmacy, Life, & Disability
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401K- Matching
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FSA
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Employee Assistance Program
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PTO and Company Paid Holidays
Primary Functions:
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Responds to provider appeals and related correspondence.
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Interacts with physician/provider offices by letter or phone to gather additional information regarding claim disputes.
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Performs a total claim review to determine over/underpayment on problem claims.
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Works with Claims Support to adjust previously processed claims.
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Documents accurately in Facets regarding outcome of claims disputes.
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Meets the departments established standards for case completion.
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Other duties as assigned.
Required Skills & Experience:
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High School education or equivalency.
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6 months - 2 years’ medical claims processing or customer service experience.
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Strong reading, writing and verbal communication skills
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Good analytical, problem solving, decision making and organizational skills.
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10 key proficiency of 105 spm net on a computer numeric keypad.
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Type a minimum of 35 wpm net on a computer keyboard.
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Ability to work under pressure and meet mandated time frames.
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Ability to read and interpret contracts and apply Moda Health policies and procedures.
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Ability to communicate positively, patiently, and courteously with callers.
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Proficiency in Facets, Content Manager and EBT.
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Proficiency in computer applications such as Word and Excel.
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Ability to maintain confidentiality and project a professional business image.
Working Conditions & Contact with Others:
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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.
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Internally with Claims, Customer Service, Healthcare Services, Membership Accounting, Information Technology, and Professional Relations. Externally with Providers, Members, Vendors, and Insurance companies.
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 [email protected] email.
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