Medical Claims Savings Coordinator I

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
Coordinate Optum TruClaim, ClearHealth Access Network (CAN) and Fee Negotiations for Bill Management services, Zelis Code Edits and Repricing and provides support for Optum, ClearHealth and Zelis vendors. This is a FT WFH role. 


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=27775724&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 education or equivalent.
• 2 years medical claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
• Strong reading, writing and verbal communication skills to communicate positively, effectively, patiently, and courteously with other staff members, vendor, providers, and members.
• Excellent analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities in a rapidly changing environment.  Must have the ability to work with frequent interruptions and demonstrate professional leadership.
• Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
• Ability to take initiative and be a self-starter.
• Ability to perform project management.
• 10-key proficiency of 105 spm net on a computer numeric keypad.
• Type a minimum of 35 wpm net on a computer keyboard.
• Good organizational ability to work under pressure to handle variety of functions and meet timelines.
• Maintain confidentiality and project a professional business presence and appearance.
• Proficiency in Facets, Benefit Tracker, Content Manager.
• Knowledge and understanding of Moda administrative policies.
• Knowledge of medical billing and coding and/or the ability to learn & apply these concepts.  Knowledge of principles of clinical editing would be helpful.  Certified Professional Coder (CPC) designation would be helpful.
• Proficiency with personal computers, Internet research, and software applications such as Excel, Word, and PowerPoint.

Primary Functions:

• Responsible for all aspects of Optum TruClaim, ClearHealth Access Network and Fee Negotiations repricing services including receiving, processing, and reporting data to and from vendors.
• Review and apply established TruClaim edits to appropriate claims from the daily TruClaim Report.
• Review and apply established repricing amounts to appropriate claims from the daily ClearHealth Network and Fee Negotiations/Bill Management reports.
• Generates weekly report of non-utilized TruClaim edits. 
• Provides suggestions to Clinical Policy & Reimbursement Analyst for needed customizations and/or ways to optimize use of TruClaim services.
• Process Optum, Clear Health, Zelis and Macro Health Vendor Payments and Refunds.
• Review and assist with member and provider disputes and appeals. 
• Process and adjust claims related to Optum, Zelis, ClearHealth, Macro/Aetna vendors.
• Demonstrates knowledge and understanding of all plan types and Moda administrative policies affecting claims processing and adjustments.
• Process vendor payments on a timely basis.
• Act as a contact person for Optum TruClaim inquiries both internally and externally.
• Provide back-up for other Optum, ClearHealth and Zelis staff members.
• Identify and refer trends in the system and procedures and recommend improvements to increase efficiency and reduce errors.
• Provide training as indicated by Supervisor.
• Perform 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.
• Inside the company with Claims, Medical Customer Service, Accounting, Sales & Service, Membership Accounting, Benefit Configuration, Information Technology, and Professional Relations. Outside the company with providers and vendors.

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 & Danielle Baker via our humanresources@modahealth.com email.