Provider Configuration QA Analyst

Job Title

Provider Configuration QA Analyst

Duration

Open until filled

Work Hybrid

Yes

Description

Let’s do great things, together!

About ModaFounded 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 SummaryThe role of a Provider Configuration QA Analyst is crucial in maintaining the integrity and accuracy of provider information within Moda Health. This position involves meticulous oversight of provider data, ensuring that all details, from demographics to assigned pricing, align with contractual agreements and organizational standards. The primary functions listed are integral to the role of a Provider Configuration QA Analyst. This position requires a meticulous approach to auditing, a deep understanding of healthcare plan benefits and pricing, and the ability to work collaboratively across departments. These functions highlight the importance of a detail-oriented mindset, strong analytical skills, and effective communication within the healthcare industry. The role is crucial for ensuring that the Facets system operates accurately and efficiently, ultimately impacting the quality of patient care and service delivery.Pay Range$22.88- $28.60 ​​​hourly (depending on experience)

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27732616&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• A bachelor’s degree or equivalent professional experience is required.

• 1-2 years of prior experience in Healthcare/Insurance, preferably with experience in provider configuration using Facets or similar systems.

• Proficiency in Microsoft Office applications, particularly Excel, Word, and Access, is essential. Ability to create SQL scripts, queries, and stored procedures to extract data from databases.

• The candidate should possess the ability to analyze and understand the business impacts across various departments.

• Apply critical thinking to address complex data-related challenges. Ability to troubleshoot data issues, identify anomalies, and propose solutions.

• In-depth knowledge of Facets and NetworX Pricer or comparable health insurance benefits systems is crucial.

• Proficiency with a 10-Key at 135 strokes per minute (spm) net and typing skills of 35 words per minute (wpm) net are required.

• Strong oral and written communication skills are necessary for effective interaction with users, systems personnel, and management.

• The capability to audit configurations with high accuracy and within set timelines is important. The ideal candidate should possess the ability to thoroughly audit system configurations, not only for the Moda Provider Configuration Analyst role but also for our offshore team. This task requires a blend of diplomacy and excellent communication skills to effectively collaborate with both local and remote team members.

• Must be able to plan, organize, and prioritize tasks to meet guidelines, deadlines, and quality objectives.

• Should be able to document business processes effectively.

• Consistent punctuality, the willingness to work extra hours as needed, and the ability to work independently with minimal supervision are expected.

• Working with both local and offshore teams requires effective collaboration. The candidate should be adept at bridging cultural and communication gaps.

Primary Functions:

• Conduct thorough audits of provider configuration and updates in Facets, including utilizing queries and other technology to analyze provider data from a global perspective.

• Meet designated turnaround times for all audit-related tasks.

• Monitor and report on trends in audit errors, offering constructive feedback.

• Perform rigorous quality assurance tests to ensure configurations meet medical claims requirements.

• Support departmental projects and contribute to reports as directed by management.

• Employ creative problem-solving skills to optimize system efficiency from a corporate standpoint.

• Evaluate cases where standard configuration does not satisfy plan requirements and explore alternative solutions.

• Demonstrate proficiency in understanding the interplay between provider information, pricing, and benefit configuration in claim adjudication.

• Document policies and business processes as per departmental directives.

• Navigate interdepartmental interactions with diplomacy, managing differing perspectives and mediating disputes effectively.

• Fulfill additional responsibilities as needed, demonstrating versatility and adaptability.

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.