Job Details

Provider Configuration Auditor

Moda Health, Portland, OR

Job - Health

Close Date: 07/31/2019

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. 

We are seeking a Provider Configuration Auditor. This position conducts quality assurance audits for varying aspects of provider configuration; tracks and trends audit results and provides feedback to supervisory staff; performs actual configuration to meet business need; attends implementation and transition meetings and assists supervisory staff to improve processes and documentation.

Primary Functions:
01.    Audits Facets configuration of providers, agreements and fee schedules, including adherence to established policies and procedures.
02.    Participates in meetings (both Implementation and others) to fully understand plan benefit impacts on pricing and validates system capabilities.
03.    Ensures turnaround times are met for all assigned audits.
04.    Tracks and trends audit error, providing feedback and suggestions for improvement to management.
05.    Performs quality assurance testing on test claims to validate configuration will meet the needs of the claims department.
06.    Interprets pricing information from the provider contract in order to ensure accuracy of configuration.
07.    Documents, tracks and updates departmental policies and business processes.
08.    Reviews situations, problems solves, 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.
09.    Assists with departmental projects and reports, including acting as a back up to lead within department.
10.    Performs 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.

Please directly apply here:

Required Skills:
01. 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.
02. Knowledge of existing configuration practices and procedures.
03. 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.
04. Ability to analyze and recognize potential business impacts for all affected departments.
05. Knowledge of Facets and Network X Preferred.
06. Experience with Provider pricing and fee schedules.
07. Ability to communicate tactfully and effectively, both verbally and in writing, with users, systems personnel and management.
08. Ability correctly interpret provider contracts to determine whether configuration matches the contract intent.
09. 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 on a daily basis.
13. Ability to work independently, with minimal supervision and in a team environment.
14. Maintain confidentiality and project a professional business image.

Complete details: