Talent.com
Govt Prior Auth Coordinator Temporary
Govt Prior Auth Coordinator TemporaryModa Health • Portland, Texas, USA
Govt Prior Auth Coordinator Temporary

Govt Prior Auth Coordinator Temporary

Moda Health • Portland, Texas, USA
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

Lets 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 were 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. Lets 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 temporary WFH role.

Pay Range

$20.88- $23.49 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.

Dental Vision &Pharmacy

  • PTO and Company Paid Holidays
  • 401k - Matching

Required Skills Experience & Education :

  • High school education or equivalent.
  • 1-2 years of experience in a medical office and / or insurance experience needed.
  • Proficient with PC and Microsoft Office applications.
  • Type a minimum of 35 wpm and 10key proficiency of 135spm on computer number keypad.
  • Excellent written verbal and interpersonal communication skills including demonstrated business writing and grammar skills.
  • Excellent organizational and detail orientation skills.
  • Must present a professional business image in all settings.
  • Ability to work well under pressure work with frequent interruptions and shifting priorities.
  • Ability to come to work on time and daily.
  • 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.
  • High level of understanding of medical terminology and coding state and federal regulations for claims adjudication and provider contracting.
  • Knowledge of Health Plan benefits.
  • Ability to interpret complex benefit packages and contract language.
  • Strong problem-solving skills and decision quality preferred.
  • Familiar with CMS (Medicare) rules and regulations a plus but not required.

    • Primary Functions :

  • Determines the requirement for prior authorization based on the plan type ICD-10 code CPT / HCPC code or place of service.
  • Review and research referral and authorization requests received in Healthcare Services. Process or route per appropriate guideline.
  • Provides education to members and providers regarding prior authorization process.
  • Interacts 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.
  • Consults 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.
  • Utilizes the Moda Health systems for documentation of contact with providers and members.
  • Communicates effectively with other Medical Management support staff.
  • Analyze claims and encounters according to the limits of authorization benefit plan and provider contracts.
  • Effectively uses the Moda Health systems to accurately determine eligibility benefit plan and physician networks associated with the members plan.
  • Completes approvals and denials by the medical director of claims and prior authorization requests in a professional positive manner.
  • Send proper correspondence to providers members and other departments to either obtain additional information necessary for the review of claims or denial of requested services.
  • Analyze authorizations for correct information such as authorization maximums limitations and special instructions for performance groups.
  • Ensure adherence of Health Insurance Portability and Accountability Act (HIPAA) and other regulatory guidelines including privacy and security.
  • Responsible for the auditing of individual daily work for accuracy consistency and compliance based on Moda Health policies and procedures state federal and CMS (Medicare) / Medicaid regulations.
  • Identifies problems and researches alternative solutions.
  • Works with other team members to maintain the workflow to meet productivity and compliance standards.
  • Completes other duties and special projects as assigned by the HCS Supervisor and / or the HCS Manager.
  • Maintains an established productivity based on the complexity and demands of a heavy workload complex services agreements provider contracts and complex benefit packages.
  • Responsible for utilizing all applicable policies procedures and materials used in determining the proper review of claims review and processing of prior authorization requests for services.
  • Enter data into appropriate system Facets UM or CT Dynamo must be able to accurately determine member eligibility and provider participation within a network.
  • Maintain accurate patient note entry when not approving a request when awaiting additional information or when routing the referral or preauthorization request.
  • Perform other tasks 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 37.5 hours per week including evenings and occasional weekends to meet business need.
  • Internally with own department and Customer Service. Externally with Moda members PBM vendor providers provider offices.

    • 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 and Danielle Baker via our email.

    Required Experience :

    IC

    Key Skills

    Corporate Risk Management,Electronics,Infection Control,Bakery,ELV,Accident Investigation

    Employment Type : Contract

    Experience : years

    Vacancy : 1

    Hourly Salary Salary : 20 - 23

    [job_alerts.create_a_job]

    Temporary Coordinator • Portland, Texas, USA

    [internal_linking.similar_jobs]
    RN, Registered Nurse - A8 - Ortho / Oncology - Med / Surg

    RN, Registered Nurse - A8 - Ortho / Oncology - Med / Surg

    CHRISTUS Health • Ingleside, TX, US
    [job_card.full_time]
    Description The medical-surgical unit at Shoreline Hospital provides exceptional care for Ortho, Oncology, and Med / Surg patients. Our RNs care for patients with elective surgeries, fractures from th...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Cook - Portland Sports Complex

    Cook - Portland Sports Complex

    The Sports Facilities Companies • Portland, TX, US
    [job_card.part_time]
    COOK - Portland Sports Complex.Sports Facilities Management, LLC.DEPARTMENT : FOOD & BEVERAGE.REPORTS TO : FOOD & BEVERAGE MANAGER. STATUS : PART-TIME (NON-EXEMPT).Portland Sports Complex is a ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    SHIFT SUPERVISOR (FULL TIME)

    SHIFT SUPERVISOR (FULL TIME)

    ESFM • Gregory, TX, US
    [job_card.full_time] +1
    We have an opening for a full time.Exxon - 4589 Farm to Market 2986, Gregory, TX 78359.Note : online applications accepted only. Full time schedule; days and hours may vary.Prior supervisory experien...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Sales Associate

    Sales Associate

    Vape City • Ingleside, TX, US
    [job_card.full_time] +1
    Vape City is seeking Sales Associates to welcome customers, guide them through the products, answer questions, and make sure guests have a pleasant experience through excellent customer service.The...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Nurse Medical Unit - Per diem

    Nurse Medical Unit - Per diem

    CHRISTUS Health • Ingleside, TX, US
    [job_card.full_time]
    The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation. Provides routine and complex care, with th...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Part-Time Side Work - Earn on Top of Your Day Job

    Part-Time Side Work - Earn on Top of Your Day Job

    Finance Buzz • Ingleside, Texas, US
    [job_card.part_time] +1
    We’re looking for people interested in a part-time remote opportunity to supplement their main income.This position is ideal for professionals, freelancers, and anyone who wants to improve their fi...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Side Hustle Coordinator (Part-Time Remote)

    Side Hustle Coordinator (Part-Time Remote)

    Finance Buzz • Taft, Texas, US
    [filters.remote]
    [job_card.full_time] +2
    We are looking for someone to take part in a program designed for people who already hold a full-time position but want extra income. You’ll explore proven side-hustle models, try them out, and find...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Extended Day Coordinator

    Extended Day Coordinator

    IRCO • Portland, Texas, USA
    [job_card.full_time]
    Non-Exempt; Administrative Support Workers; 8864.Starting at $18 per hour based on experience.Non-Exempt; Professional; 8864. Gilbert Park Elementary 13132 SE Ramona St Portland OR 97236.Oncall / Cas...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Adventure Travel Coordinator

    Adventure Travel Coordinator

    Kim Luxe Travel • Portland, Texas, USA
    [job_card.full_time]
    We are hiring an Adventure Travel Coordinator to support clients planning activity-focused or exploration-based travel.This position is ideal for someone who enjoys research planning and helping tr...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Reserve Prosthodontist

    Reserve Prosthodontist

    United States Army • Portland, TX, United States
    [job_card.full_time]
    THE ARMY HEALTH CARE ADVANTAGE As a member of the Army health care team, you’ll receive benefits that you won’t be able to get in a civilian career. Challenging Work Feel inspired with great case di...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Portland Central & Portland East (OR) Area Admin II

    Portland Central & Portland East (OR) Area Admin II

    Young Life • Portland, Texas, USA
    [job_card.part_time]
    If you are currently on Young Life staff pleasedo not apply through this external jobs apply for internal job opportunities log in to Workday and use the. Applying externally may delay your applica...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Food & Beverage Team Member - Portland Sports Complex

    Food & Beverage Team Member - Portland Sports Complex

    The Sports Facilities Companies • Portland, TX, US
    [job_card.full_time]
    FOOD & BEVERAGE TEAM MEMBER -.Sports Facilities Management, LLC.DEPARTMENT : FOOD & BEVERAGE.STATUS : PART- TIME (NON-EXEMPT). Portland Sports Complex is a premier sports, recreation and enter...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Care Management Nurse - (Part-time)

    Care Management Nurse - (Part-time)

    CHRISTUS Health • Portland, TX, US
    [job_card.full_time] +1
    Description Summary : The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Registered Nurse - Medical Unit - Full Time -

    Registered Nurse - Medical Unit - Full Time -

    CHRISTUS Health • Gregory, TX, United States
    [job_card.full_time]
    Description Summary : The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine ...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Registered Nurse - Telemetry Unit - Full time

    Registered Nurse - Telemetry Unit - Full time

    CHRISTUS Health • Gregory, Texas, United States
    [job_card.full_time]
    Description Summary : The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine and ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Professional Pet Groomer - Part Time

    Professional Pet Groomer - Part Time

    My Pet's Vet - San Antonio • Bayside, TX, US
    [job_card.part_time]
    We Would Love for You to Join the My Pet’s Vet Family!.My Pet's Place is looking for a Professional Groomer at our new.We are looking for a candidate who loves animals and understands the...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Temporary Early Childhood Development Specialist 7 Hours Lincoln Park Elementary School

    Temporary Early Childhood Development Specialist 7 Hours Lincoln Park Elementary School

    David Douglas Sd 40 • Portland, Texas, USA
    [job_card.full_time]
    Temporary Early Childhood Development Specialist.Lincoln Park Elementary School.December 15 2025 - June 11 2026.The David Douglas School District welcomes applications from candidates that expand t...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Assistant Principal (Full Time) at Centennial High School

    Assistant Principal (Full Time) at Centennial High School

    Centennial Sd 28J • Portland, Texas, USA
    [job_card.full_time]
    July 1 2026 or earlier depending upon availability.The position of Assistant Principal - High School is done for the purposes of. Provides strong instructional leadership.Facilitates communication a...[show_more]
    [last_updated.last_updated_1_day] • [promoted]