Moda Health Provider Configuration Specialist in Portland, Oregon
Provider Configuration Specialist
Provider Configuration Specialist
Open Until Filled
Job Class - 107.0
Let’s do great things, together
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.We are currently seeking a Medical Provider Configuration Analyst. The Medical Provider Configuration Analyst I 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 of these functions drive Moda’s ability to accurately price and auto-adjudicate claims. Analyze and research moderately complex provider and network configuration issues.
Primary Functions:1. 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.2. 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.3. Analyzes provider network participation across a large and growing number of networks, each with unique and changing requirements. 4. Loads provider network and pricing rules based on complex and frequently changing internal processes.5. Researches and resolves low to moderately complex issues that are sent from Claims, Customer Service, Provider Relations, Credentialing and Appeals.6. Other duties as assigned.
Are you ready to be a betterist?
If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.
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.
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.
Ability to come into work on time and on a daily basis.