Provider Config Auditor

Moda Health•Portland, OR

1d•Remote

About The Position

Conducts quality assurance audits for varying aspects of provider configuration. Tracks and trends audit results to provide feedback to supervisory staff. Performs actual configuration to meet business need. Attends implementation and transition meetings and assists Lead to improve processes and documentation. This is a FT WFH position.

Requirements

Bachelor’s degree or equivalent work experience.
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.
Knowledge of existing configuration practices and procedures.
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.
Ability to analyze and recognize potential business impacts for all affected departments.
Strong system knowledge of Facets and NetworX Pricer, or similar Health Insurance benefits systems.
Ability to communicate tactfully and effectively, both verbally and in writing, with users, systems personnel, and management.
Ability correctly interpret provider contracts to determine whether configuration matches the contract intent.
Ability to audit configuration with a high degree of accuracy within established timelines.
Ability to plan, organize and prioritize task assignments to ensure established guidelines, timelines and quality goals are met.
Ability to document business processes.
Ability to come in to work on time and daily.
Ability to work independently, with minimal supervision and in a team environment.
Maintain confidentiality and project a professional business image.
Educational requirements, which may include educational degrees, professional licenses, or other specialized skills.
Work habits required, which may include regular attendance, teamwork, initiative, dependability, promptness, ability to work overtime.
Interpersonal skills required.
Provide necessary skills for the job, including mental, technological, and physical requirements.

Nice To Haves

Preference for those with experience building benefits in Facets and/or other claims systems.

Responsibilities

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