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.

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.

Please refer the Job description for details