Medicaid Provider Relations Rep II

Moda Health

Job Location:

Portland, TX - USA

Monthly Salary: $ 54668 - 68340

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

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 provides concierge customer service to providers by being the liaison between the Medicaid plans. The Provider Relations Representative is responsible for presenting promoting and resolving concerns and issues brought forward by providers and internal staff and develop improve and streamline existing provider policies with the goal of removing barriers to providing care. This role will also implement projects and policies that impact providers (includes drafting communications frequently asked questions resource guides) to support network needs and promote strong collaborative role will also plan prepare and develop training materials for contracted providers and will conduct face-to-face trainings throughout the year. Internally this role will work closely with our Lead Medicaid Provider Relations Representative for other Medicaid lines of business multiple departments and is a critical role in supporting daily operations. This is a FT hybrid position based in Portland Oregon.

Pay Range
$54668.32 - $68340.67 salary (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 Life & Disability

401K- Matching

FSA

Employee Assistance Program

PTO and Company Paid Holidays

Required Skills Experience & Education:

Three or more years of provider relations experience.
Requires expertise in industry practices specialized payment methodologies Value Based Care agreements Payer/Provider Strategic Partnerships and all relevant regulations.
College degree in health care business analytics or related field or equivalent work experience.
Knowledge of Medicaid claims and benefits.
Proficient in identifying and interpreting Oregon Administrative Rules CCO and provider contracts
Knowledge of provider payment methodologies including capitation DRG CAH and other facility and professional pricing.
Ability to analyze and validate provider claims and payment data.
Experience in manual processing of high dollar checks.
Judgement self-motivation and the ability to work independently and as part of a team.
Is detail oriented and possess strong analytical and problem-solving skills.
Skilled at delivering trainings and facilitating meetings.
Strong interpersonal communication skills and the ability to develop effective relationship with
network providers members and partners.
Proficiency in Microsoft Word Excel and PowerPoint.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Must be willing to travel for provider training sessions.
Knowledge of Oregons Coordinated Care Organization (CCO) Infrastructure.
Must be able to represent the organizations at outside meetings conferences and events in a positive
and professional manner.
Must maintain confidentiality and project a professional business image.

Preferred Skills Experience & Education:

Knowledge of medical office workflows.
Knowledge of other Moda Health products plans and networks.

Primary Functions:

Assist leadership in negotiating Single Case Agreements; review contract terms to ensure they can be operationalized.
Validation of bi-annual Delivery System Network (DSN) Report in partnership with analytics.
Assists with state federal and other entity related audits.
Contract configuration implementation validation and assessment.
Implement and coordinate new Medicaid provider focused initiatives.
Identify root causes of claim problems and trends and participate in developing solutions. This includes performing research through available systems policies and departments ensuring timely resolution is achieved.
Work in a consultative role with various departments creating effective processes and updates.
Review and update Medicaid provider manuals policies and procedures as well as desk manuals.
Oversight and management of Medicaid provider webpage content.
Utilize best practice policies and procedures work guides or tools to provide improved department process workflows.
Coordinate and participate in targeted provider meetings including annual Provider Workshops.
Educate providers on Oregon Administrative Rules and contract language ensuring consistent interpretation.
Provide timely responses to all provider inquiries within two to three business days.
Provides ongoing support to the Medicaid Operations team.
Process provider enrollment applications and meet timelines established by management.
Complete and validate Medicaid encounter data.
Conduct on-site provider visits to create strategic provider partnerships to improve health efficiencies and foster provider experience.
Attend State and other Medicaid related meetings to learn about new policy and initiative changes that have an impact on operations.
Perform other duties and special projects assigned.

Working Conditions & Contact with Others

Position is hybrid based in Portland Oregon. Extensive close PC and keyboard work. Occasional require travel to off-site meetings which may include overnight stays.
Internally with multiple departments. Externally with providers providers staff office administrators external partners Oregon Health Authority staff.

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 & Danielle Baker via email.

Lets do great things together!About ModaFounded 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 commu...