Provider Config Auditor

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
Conducts quality assurance audits for varying aspects of provider configuration. Tracks and trends audit results to provide feedback to supervisory staff. Performs actual configuration to meet business need. Attends implementation and transition meetings and assists Lead to improve processes and documentation. This is a FT WFH position.

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.

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. Bachelors degree or equivalent work experience.
2. At least 2 years experience in health insurance industry with a preference for those with experience building benefits in Facets and/or other claims systems.
3. Knowledge of existing configuration practices and procedures.
4. Strong proficiency in Microsoft Office applications with the ability to type a minimum of 35 wpm and have a 10key proficiency of 135 spm on computer keypad/numeric pad.
5. Ability to analyze and recognize potential business impacts for all affected departments.
6. Strong system knowledge of Facets and NetworX Pricer or similar Health Insurance benefits systems.
7. Ability to communicate tactfully and effectively both verbally and in writing with users systems personnel and management.
8. Ability correctly interpret provider contracts to determine whether configuration matches the contract intent.
9. Ability to audit configuration with a high degree of accuracy within established timelines.
10. Ability to plan organize and prioritize task assignments to ensure established guidelines timelines and quality goals are met.
11. Ability to document business processes.
12. Ability to come in to work on time and daily.
13. Ability to work independently with minimal supervision and in a team environment.
14. Maintain confidentiality and project a professional business image.
15. Educational requirements which may include educational degrees professional licenses or other specialized skills. If exceptions may be made state that.
16. Work habits required which may include regular attendance teamwork initiative dependability promptness ability to work overtime.
17. Interpersonal skills required.
18. Provide necessary skills for the job including mental technological and physical requirements

Primary Functions:

1. Audits Facets configuration of providers agreements and fee schedules including adherence to established policies and procedures.
2. Participates in meetings (both Implementation and others) to fully understand plan benefit impacts on pricing and validates system capabilities.
3. Ensures turnaround times are met for all assigned audits.
4. Tracks and trends audit error providing feedback and suggestions for improvement to management.
5. Performs quality assurance testing on test claims to validate configuration will meet the needs of the claims department.
6. Interprets pricing information from the provider contract to ensure accuracy of configuration.
7. Documents tracks and updates departmental policies and business processes.
8. Reviews situations problem solve and identifies when/if configuration is not the most efficient use of system. Works with management to determine other options cross functionality and identify the workflow configuration and associated business processes.
9. Assists with departmental projects and reports including acting as a back up to lead within department.
10. Performs other duties as assigned.

Working Conditions:

• Office environment with extensive close PC and keyboard use constant sitting and frequent phone communication. Must be able to navigate multiple computer screens. A reliable high-speed hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek including evenings and occasional weekends to meet business need.
• Internally with multiple departments. Limited external contact.

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.