Prior Auth Coordinator - Temporary

Overview

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.

Let’s do great things, together!

This position will provide support to the Medical Management team by assisting in the investigation and research of prior authorization requests. Completes reviews or supports the clinical staff in the review processes by preparing or completing the requests as assigned. This is a Temporary WFH role.

$18.03 - $20.18 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.

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• Medical, Dental, Vision & Pharmacy
• PTO and Company Paid Holidays
• 401k - Matching

• High school education or equivalent.
• 1-2 years of experience in a medical office and/or insurance experience needed.
• Strong problem-solving skills and decision quality preferred.
• High level of understanding of medical terminology and coding, state and federal regulations for claims adjudication and provider contracting.
• Knowledge of Health Plan benefits.
• Type a minimum of 35 wpm and 10key proficiency of 135spm on computer number keypad.
• Proficient with PC and Microsoft Office applications.
• Excellent written, verbal, and interpersonal communication skills including demonstrated business writing and grammar skills.
• Ability to interpret complex benefit packages and contract language.
• Excellent organizational and detail orientation skills.
• Ability to work independently, as well as part of a team, dealing with all levels of staff, members, providers, in a professional manner.
• Ability to maintain confidentiality.
• Ability to come to work on time and daily.
• Ability to work well under pressure, work with frequent interruptions and shifting priorities.
• Must present a professional business image in all settings.

• Review and research referral and authorization requests received in Healthcare Services. Process or route per appropriate guideline.
• Determine the requirement for prior authorization based on the plan type, ICD-10 code, CPT/HCPC code or place of service.
• Provide education to members and providers regarding prior authorization process.
• Interact with providers and provider offices to gather complete, accurate information to process prior authorizations and referrals and coordinates with providers to ensure consideration is given to unique treatment.
• Consult with the RN, Manager or Supervisor on complex cases.
• Responsible for daily administrative functions of the clinical team in Healthcare Services, ensuring deadlines are met to support required processes of the clinical team, members and providers as well as facilitates the timely processing of documentation submitted to the Medical Management department.
• Utilize the Moda Health systems for documentation of contact with providers and members.
• Communicate effectively with other Medical Management support staff.
• Analyze claims and encounters according to the limits of authorization, benefit plan and provider contracts.
• Effectively use the Moda Health systems to accurately determine eligibility, benefit plan, and physician networks associated with the member’s plan.
• Complete approvals, and denials by the medical director, of claims and prior authorization requests in a professional, positive…