Provider Relations Rep II

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
Provide exceptional customer service to contracted providers by being the liaison between the contracted provider and the Health Plan. The Provider Relations Representative is responsible for presenting, promoting, and resolving concerns and issues brought forward by the providers or the Health Plan. This is a FT WFH role.

Pay Range
$54,668.32 - $68,340.67 salary (depending on experience) This role may be classified as hourly (non-exempt) depending on the applicant's location. 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=27766294&refresh=true

Benefits:

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

Required Skills, Experience & Education:

Primary Functions:

1. Identify root cause of claims problems, trends, and participate in developing solutions. This includes performing research through available systems, policies and departments ensuring timely resolution.
2. Develop and review Dashboard metrics (quality, financial, triple AIM) and translate into actionable items based on group specifics.
3. Ability to provide actionable financial and operational data and to ensure action plans are implemented to achieve performance goals.
4. Work in a consultative role with various departments locally creating effective information and analyses to optimize the market’s strategic objectives for providers.
5. Provide timely responses to all provider inquiries, within in three business days.
6. Conduct regular on-site provider visits to create strategic provider partnerships to improve health efficiencies, and foster provider experience while ensuring cohesion across product lines with Moda’s policies. All providers should be provided with an invitation for such on-site visits. There should be a minimum of 36 visits on average per year (three per month).
7. Educate providers on their health plan contract language ensuring consistent interpretation.
8. Organize, prepare, and present annual Provider Workshops. Workshops are our opportunity to foster relationships, provide education and represent Moda in a positive light.
9. Participate in ongoing Moda committees with the expectation of providing feedback and recommendations from the Provider Relations perspective while bringing back pertinent information.
10. Utilize necessary resources, tools and navigate systems efficiently to provide accurate and timely responses to inquiries
11. Represent Moda in a positive and professional manner at all times.
12. Collaborate with other teams, peers, and management to identify areas of inefficiency and process improvement opportunities.
13. Other duties as assigned

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
• Internally with Health Services, Sales, Contracting, Network Adequacy, Compliance, Customer Service, Marketing, Underwriting, Claims, Claims Support, and Document Services. Externally with contracted providers, clinic administrators, hospital executives, provider billing staff and IPA administrators.

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 & Danielle Baker via our humanresources@modahealth.com email.