Medical Provider Configuration - Temporary

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.

Job Summary
The Medical Provider Configuration role is responsible for analyzing provider data from Modas systems and information received through various channels. This role involves configuring demographic information in compliance with CMS state and internal guidelines. Additionally it includes reviewing provider participation across multiple states and networks ensuring accurate network configuration and pricing rule application based on internal guidelines. These functions are essential for Modas ability to price claims accurately and support autoadjudication. The role also includes identifying and resolving basic provider and network configuration issues.This is a Temporary FT WFH role.

Pay Range
$18.03 $20.18 hourly DOE.
*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:

Required Skills Experience & Education

• High school diploma or equivalent; college degree preferred.

• Prior experience in a medical or health insurance setting preferred with an understanding of medical and health insurance terminology.

• Proficiency in PC use including experience with multiple data systems and webbased applications.

• Strong verbal written and interpersonal communication skills.

• Typing proficiency of 35 WPM and 10key proficiency of 135 SPM.

• Strong research analytical and problemsolving skills to evaluate complex issues and develop effective solutions.

• Ability to learn and apply new concepts quickly.

• Good organizational skills with the ability to manage multiple tasks efficiently.

• Ability to analyze and interpret data from various systems and reports.

• Understanding of data integrity and quality assurance principles.

• Strong memorization skills and critical thinking abilities for efficient recall and issue resolution.

• Ability to follow established procedures for data validation and roster preparation.

• Proficiency in Excel including basic formulas modification and applying filters with accuracy and consistency.

• Efficient navigation and file management in a Windows environment with a complex folder structure.

• Ability to work well under pressure with frequent interruptions and shifting priorities.

• Consistent punctuality and adherence to a daily work schedule in a remote setting.

• Demonstrates sound judgment professionalism and a commitment to maintaining a positive and respectful work environment.

• Willingness to learn and grow within the role.

Primary Functions

• Configure and maintain new and existing providers in Facets ensuring compliance with company state and CMS requirements through accurate and timely research verification and analysis.

• Resolve provider configuration issues within established processes and timelines.

• Analyze provider network participation across multiple networks and states adapting to unique and evolving requirements.

• Configure provider networks and agreements in accordance with internal guidelines.

• Perform other duties as assigned.

Contact with others & Working Conditions

• Internally with multiple departments. Externally with provider office personnel.
• 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.