Moda Health. Healthcare from your head to your toes.

Criminals posing as online job recruiters may try to get personal information from job applicants, even sending them fake employment offers so they will submit personal information. Moda does not send checks to job applicants, and Moda does not ask applicants to transfer money to a third party. To verify any online conversation you think you may be having with a Moda representative, simply email the Human Resources Department directly at humanresources@modahealth.com.

Moda Health and its affiliates will only employ qualified applicants that live in one of the following states: AK, AZ, ID, OR, TX, or WA. If you do not live in one of these states or are not planning to relocate, your application will not be considered.

All successfully received applications will receive an email from humanresources@modahealth.com confirming your submittal status and username. Please check your spam folder. If you have NOT received this email confirmation, please reapply.

Moda Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, sexual orientation, gender identity or expression, religion, national origin, marital status, age, disability, veteran status, genetic information, or any other protected status. Reasonable accommodations may be made throughout the application and interview process if requested.
Know Your Rights: Workplace Discrimination is Illegal

Medical Claims Pricer I

Job Title
Medical Claims Pricer 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.


Position Summary
Responsible for utilizing resources to efficiently review, price and process medical claims with outside vendors.  Handle complex file reviews related to network pricing.  This is a FT WFH role. 


Pay Range
$19.05 - $21.43 ​​​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=27758451&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.
  • 2 – 3 years medical/dental claim processing or customer service dealing with all types of plans/claims.
  • Professional and effective written and verbal communication skills.
  • Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities.
  • 10-key proficiency of 105 spm.
  • Type a minimum of 45 wpm.
  • Good organizational ability to work under pressure to handle variety of functions and meet timelines.
  • Ability to maintain confidentiality and project a professional business image.
  • Ability to come into work on time and on a daily basis.
  • Proficient with Facets, Word, and Excel.


Primary Functions:

  • Prices and processes medical claims with outside vendors including First Choice, IPN, Healthy Directions, PHCS-PPO, and First Health.
  • Work closely with Medical Professional Relations, Customer Service, and Support on pricing requests.
  • Able to differentiate between all plan types when processing claims for multiple groups.
  • Identify inconsistencies with network setups.
  • Contacts outside vendors related to pricing and website issues.
  • Review, analyze and resolve claims through the utilization of available resources including P&Ps, member handbooks, provider contracts, and EBT.
  • Complete complex file reviews associated with network pricing.
  • Handle claim adjustments related to network pricing.
  • Assist with Member and Providers Appeals related with network pricing.
  • 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 40 hours per week, including evenings and occasional weekends, to meet business need.
  • Internally with Medical Claims, Customer Service, Support, Medical Professional Relations.  Externally with outside 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.

Should you need an accommodation in applying to any of our open positions, please contact Human Resources at hradmin@modahealth.com or 503-228-6554.