Provider Config Analyst I - Moda Health

Let’s 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, we’re 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. Let’s be better together.

Position Summary
We are currently seeking a Provider Configuration Analyst. This position analyzes provider data from Moda’s systems and information received from providers via a wide array of work streams, and updates demographic information in compliance with CMS, State and internal guidelines. Also analyzes provider participation across a wide range of states and networks and adds/updates network participation along with established pricing rules based on complex and frequently changing internal rules and guidelines. Both functions drive Moda’s ability to accurately price and auto-adjudicate claims. Analyze and research moderately complex provider and network configuration issues. This is a FT WFH position.


Pay Range
$19.05- $23.81 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.

https://j.brt.mv/jb.do?reqGK=27740454&refresh=true

 

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• High School diploma or equivalent.  College degree is a plus.
• Minimum 1 year experience in a medical billing office, or medical claims/customer service; with understanding of medical and health insurance terminology.
• Knowledge of credentialing processes and familiar with Cactus or credentialing vendor.
• PC proficiency with advanced ability to complete tasks using multiple data systems and internet programs
• Strong verbal, written and interpersonal skills.
• Typing proficiency of 35 wpm and 10-key proficiency of 135 spm.
• Demonstrates research and problem solving skills. 
• The ability to analyze and interpret data via systems and reports, with the ability to write query requests for system reports.
• Ability to work well under pressure with frequent interruptions and shifting priorities.

Primary Functions:

• Loads and maintains new and existing providers in Facets in accordance with company, State and CMS requirements, which includes performing accurate and timely provider research, verification and analysis.  Resolves provider load issues within established documented processes.
• Analyzes and compares provider demographic information from a wide variety of source data as well as the system and determines appropriate action to be taken.  Includes the use of queries and spreadsheets to compare large amounts of data.
• Analyzes provider network participation across a large and growing number of networks, each with unique and changing requirements.
• Loads provider network and pricing rules based on complex and frequently changing internal processes.
• Researches and resolves low to moderately complex issues that are sent from Claims, Customer Service, Provider Relations, Credentialing and Appeals.
• Perform other duties as assigned.

 

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 and Daniel McGinnis via our humanresources@modahealth.com email.