Membership Acct Qual Analyst Internal Applicants Only

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
Provide accurate quality assurance auditing of pre and post enrollment billing and reconciliation functions as performed by Membership Accounting specialists of all levels. Track and report on quality trending as it relates to specific specialists as well as department level production. This is a full-time hybrid position based in Portland Oregon.

Pay Range
$22.88 - $25.74 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

Dental Vision Pharmacy Life & Disability

Required Skills Experience & Education:

1. High School diploma or equivalent required.
2. 1-2 years quality review experience in a health insurance environment preferably in a Membership Accounting (enrollment billing & reconciliation) department preferred.
3. Demonstrate strong effective and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player.
4. Knowledge of Word Excel and ability to navigate web-based programs.
5. Excellent reading verbal and written communication skills and the ability to interact professionally patiently and courteously with others.
6. Good analytical problem solving decision making and organizational and detail-oriented skills with ability to shift priorities.
7. Ability to come in to work on time and on a daily basis. Maintain attendance above company standards.
8. Maintain confidentiality and project a professional business presence and appearance.

Primary Functions:

1. Audit enrollments billings and reconciliation daily using statistically valid sampling methodology using prescribed audit criteria. Performs simple adjustments as necessary.
2. Ensures departmental quality assurance standards employer group Statement of Work and State and Federal Regulations are adhered to through auditing all Membership Accounting Specialist duties.
3. Conduct in-depth enrollment billing and reconciliation on performance groups as well as focused audits for specifically identified situations or specialists on a scheduled basis.
4. Prepares required monthly and/or quarterly reports for specific group performance guarantees production and accuracy results.
5. Identify trends from audit results and recommend improvements to increase overall quality.
6. Creates and updates documentation department procedures and resource materials as needed.
7. Responsible for quality and continuous improvement within job scope.
8. Contributes to and supports the companys quality initiatives by encouraging team and individual contributions toward the companys quality improvement efforts.
9. Fosters and atmosphere of team spirit and portrays an outgoing and positive attitude with peers Moda and BHS Leadership Customers trainees and Specialists.
10. Responsible for regularly scheduled operational audits of staff members for your respective team and product line.
11. Other duties as assigned.