Website Moda Health
The Moda Health is looking for highly talented and motivated individuals for their Portland, OR 97204 (Downtown area) clinics. If you are interested in the long-term career progression then apply for Dental Claims Support Processor in Portland, OR 97204 (Downtown area).
Job: Dental Claims Support Processor
Company: Moda Health
Location: Portland, OR 97204 (Downtown area)
Let’s do great things, together
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 Health is seeking a Dental Claims Support Processor that will be responsible in reviewing claims to determine the reason the claim did not auto-adjudicate. Make corrections as necessary and process claims according to processing policies and contract provisions.
1. Uses contract notes and the processing manual to apply correct group specific and standard contract benefits to process pended claims. Possesses benefit knowledge by plan and determined eligibility and whether or not claim qualifies for benefits and how the system should pay. Enters in information to correctly pay benefits.
2. Documents in a clear and concise manner and analyzes and interprets existing file notes and documentation.
3. Communicates by telephone with members, providers, and other insurance carriers.
4. Sends custody, primary payment, refund request, and other form letters in a timely manner.
5. Performs basic and complex adjustments on previously processed claims.
6. Investigates and processes COB claims in a timely manner and updates information as required.
7. Performs detailed claims files review to determine over/underpayments and provides back up to claims processing and training units when needed.
8. Responds to and follows up with Customer Service tasks/issues.
9. Performs other duties as assigned.
Are you ready to be a betterist?
If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.
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.
1. High school diploma or equivalent. 2. 10-key proficiency of 105 kspm net on a computer numeric keypad. 3. Type a minimum of 35 wpm net on a computer keyboard. 4. Ability to achieve and maintain quality and quantity standards 5. Possess legible hand writing. 6. Knowledge of dental terminology, and ADA codes, preferred. 7. Data Entry experience dealing with all types of plans/claims preferred. 8. Good reading, verbal and written communication skills. Ability to listen and communicate clearly and interact professionally, patiently and courteously with co-workers and supervisor. 9. Analytical, problem solving, and decision making skills. Detail oriented and good memory retention with ability to shift priorities. 10. Good organizational skills, ability to work well under pressure and ability to handle a variety of functions in order to meet timelines. 11. Ability to interpret contracts and apply MODA Policies and Procedures to claims processing. 12. Ability to come into work on time and on a daily basis. 13. Ability to maintain confidentiality and project a professional business image.
To apply for this job please visit ejob.bz.