Prior Authorization Coordinator

Position: Prior Authorization Coordinator I
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!

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

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

This is a FT WFH role.

Pay Range

$21.30 - $23.96 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.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K
  - Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education

• 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.

Primary Functions

• Review and research referral and authorization requests received in Healthcare Services. Process or route per appropriate guideline.
• Determines the requirement for prior authorization based on the plan type, ICD-10 code, CPT/HCPC code or place of service.
• Provides education to members and providers regarding prior authorization process.
• Interacts with providers and provider offices to gather complete, accurate…