Inpatient Claims Processor I

## About the Role As an Inpatient Claims Processor I at Moda Health, you will play a vital role in ensuring the timely and accurate payment of commercial and Medicaid inpatient hospital claims. This position requires strong analytical and problem-solving skills, as well as the ability to work well under pressure. You will be part of a team that values diversity and inclusion, and you will be expected to maintain a high level of confidentiality in your work. The role entails reviewing, processing, and adjusting inpatient claims, as well as answering internal questions and responding to correspondence from providers. You will work closely with various departments, including Healthcare Services, Membership Accounting, and Customer Service. Moda Health is a company that prioritizes quality and comprehensive benefits for its employees. As a remote worker, you will have the opportunity to work from home while being part of a team that makes a difference in the healthcare sector.

## What You Will Do - Review, process, and adjust commercial and Medicaid inpatient claims - Analyze claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures - Apply plan concepts to claims, including deductible, coinsurance, copay, and out-of-pocket expenses - Examine claims to determine if further investigation is needed from other departments - Contact providers and other outside sources for additional information - Adjudicate claims to achieve quality and production standards - Release claims by deadlines to meet company, state regulations, and contractual agreements - Review Policy and Procedures for process instructions and provide suggestions for potential process improvements - Perform all job functions with a high degree of discretion and confidentiality

## What We Are Looking For - High school diploma or equivalent - 1-2 years of medical claims processing experience - 10-key proficiency of 135 wpm - Type a minimum of 35 wpm - Knowledge of medical terminology, CPT codes, and ICD-10 codes - Strong verbal, written, and interpersonal communication skills - Analytical, problem-solving, and organizational skills - Ability to work well under pressure and maintain confidentiality - Ability to maintain balanced performance in areas of production and quality

## Nice to Have - Experience with claims processing software - Knowledge of Medicare and Medicaid regulations - Certification in medical billing or coding

## Benefits and Perks - Medical, dental, vision, pharmacy, life, and disability insurance - 401K matching and FSA - Employee Assistance Program - PTO and company-paid holidays - Remote work arrangement - Opportunities for professional development and growth

- Develop a strong understanding of medical terminology and coding principles to stand out in this role.

• Familiarize yourself with claims processing software and technology to increase efficiency and accuracy.
• Highlight your analytical and problem-solving skills in your application, as these are essential for success in this position.
• Be prepared to provide examples of times when you had to maintain confidentiality in a previous role.
• Consider obtaining certification in medical billing or coding to demonstrate your expertise and commitment to the field.
• Research Moda Health's commitment to diversity and inclusion to understand the company culture and values.
• Prepare to discuss your experience with adjusting claims and applying plan concepts in an interview setting.