Membership Acct Qual Analyst

Moda Health•Portland, OR

6d•Hybrid

About The Position

Provide accurate quality assurance auditing of pre and post enrollment, billing and reconciliation functions as performed by Membership Accounting specialists of all levels. Track and report on quality trending as it relates to specific specialists as well as department level production.

Requirements

High School diploma or equivalent required.
1-2 years quality review experience in a health insurance environment, preferably in a Membership Accounting (enrollment, billing & reconciliation) department preferred.
Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player.
Knowledge of Word, Excel, and ability to navigate web-based programs.
Excellent reading, verbal, and written communication skills, and the ability to interact professionally, patiently, and courteously with others.
Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities.
Ability to come in to work on time and on a daily basis.
Maintain attendance above company standards.
Maintain confidentiality and project a professional business presence and appearance.
Must be able to navigate multiple computer screens.
A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
Must be comfortable being on camera for virtual training and meetings.

Nice To Haves

1-2 years quality review experience in a health insurance environment, preferably in a Membership Accounting (enrollment, billing & reconciliation) department.

Responsibilities

Audit enrollments, billings and reconciliation daily using statistically valid sampling methodology, using prescribed audit criteria.
Performs simple adjustments as necessary.
Ensures departmental quality assurance standards, employer group Statement of Work, and State and Federal Regulations are adhered to through auditing all Membership Accounting Specialist duties.
Conduct in-depth enrollment, billing, and reconciliation on performance groups, as well as focused audits for specifically identified situations or specialists on a scheduled basis.
Prepares required monthly and/or quarterly reports for specific group performance guarantees, production, and accuracy results.
Identify trends from audit results and recommend improvements to increase overall quality.
Creates and updates documentation, department procedures, and resource materials as needed.
Responsible for quality and continuous improvement within job scope.
Contributes to and supports the company’s quality initiatives by encouraging team and individual contributions toward the company’s quality improvement efforts.
Fosters and atmosphere of team spirit and portrays an outgoing and positive attitude with peers, Moda and BHS Leadership, Customers, trainees, and Specialists.
Responsible for regularly scheduled operational audits of staff members for your respective team and product line.
Other duties as assigned.