Job Details

Medical Provider Relations Representative

Moda Health , Portland, OR

Job - Health

Close Date: 08/24/2019

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.

Currently, Moda Health is seeking a Provider Relations Representative to liaison between the providers and the Health Plan to present, promote and resolve concerns and issues of the providers.

Primary Functions:
1. Identify root cause of claims problems and trends and participate in developing solutions.
2. Represent Moda at meetings and events at which contracted Moda Providers and potential Moda Providers will be attending.
3. Conduct on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with health plan policies, and procedures.
4. Educate providers on their health plan contract to ensure it is implemented properly.
5. Develop and maintain professional relationships with providers and the health plan
6. Troubleshoot, research and problem solve provider issue and concerns both in person and over the phone.
7. Assist provider in obtaining information on benefits and policies. Train and orient provider office staff.

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.

Please apply directly here: https://j.brt.mv/ATS/jb.do?reqGK=27240848&refresh=true

Required Skills

1. College degree or equivalent work experience in the managed care field
2. Conduct on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with health plan policies, and procedures
3. Strong verbal, written, and interpersonal communication skills.
4. Possess analytical, problem-solving and attention-to-detail skills.
5. Knowledge of the principles and processes of managed care reimbursement methodologies including but not limited to DRG and APC pricing.
6. PC proficiency, preferably with Microsoft Word and Excel.
7. Ability to work well under pressure, work with frequent interruptions and shifting priorities.
8. Maintain confidentiality and project a professional business image.
9. Assist provider in obtaining information on benefits and policies. Train and orient provider office staff.
10. Identify root cause of claims problems and trends and participate in developing solutions.

Complete details: https://j.brt.mv/ATS/jb.do?reqGK=27240848&refresh=true