Provider Config QA Analyst

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
The Medical Provider Configuration QA Analyst ensures the accuracy and quality of provider configuration work completed by other analysts. This role involves auditing analyzing and improving configuration processes to maintain data integrity and optimal system performance. This is a FT WFH position.

Pay Range
$49878.77 - $62348.47 salaried(depending on experience). This role may be classified as hourly (non-exempt) depending on the applicants location. 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 in healthcare administration information systems or equivalent experience.
2. 35 years of experience in healthcare provider configuration or a similar role.
3. Strong knowledge of Facets or similar health insurance systems.
4. Understanding of medical terminology healthcare plan benefits pricing and the ability to apply complex healthcare rules and company policies.
5. Proficient in SQL for data extraction and analysis.
6. Proficient in Microsoft Office especially Excel including advanced functions pivot tables macros and data modeling.
7. Experience with data visualization tools.
8. Excellent attention to detail and strong analytical skills with the ability to analyze large data sets approach problems from multiple angles and draw meaningful conclusions.
9. Experience with quality assurance methods including designing and implementing QA processes.
10. Strong written and verbal communication skills; skilled at creating clear reports and presentations for both technical and non-technical audiences.
11. Strong critical thinking skills focused on process improvement and turning complex data findings into actionable insights.
12. Ability to work independently and collaboratively within a remote team.
13. Excellent time management and organizational skills.
14. Ability to handle confidential information with care.
15. Maintain a professional appearance and demeanor in all internal and external interactions.

Primary Functions:

1. Audit provider configuration work using various tools including SQL to validate complex data.
2. Create and maintain Excel models to compare data identify trends and detect issues.
3. Analyze quality and compliance data using Excel and SQL and produce detailed reports.
4. Design and implement solutions that address quality issues in the Provider Configuration department.
5. Create dashboards and reports using Excel and SQL to track performance and quality metrics.
6. Analyze provider information contract details and pricing using SQL and Excel pivot tables.
7. Collaborate with IT and other departments to develop strong data validation processes.
8. Provide data-driven insights to leadership and constructive feedback to analysts for improvement.
9. Maintain a library of SQL queries and Excel templates for common audit tasks.
10. Use complex data analysis to inform decisions about process improvements.
11. Perform 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 Medical Professional Relations Provider Contracting Claims and Customer Service. Externally with provider office personnel.

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.