Provider Config QA Analyst

Moda Health•Portland, OR

2d•Remote

About The Position

The Medical Provider Configuration QA Analyst ensures the accuracy and quality of provider configuration work completed by other analysts. This role involves auditing, analyzing, and improving configuration processes to maintain data integrity and optimal system performance. This is a FT WFH position.

Requirements

Bachelor’s degree in healthcare administration, information systems, or equivalent experience.
3–5 years of experience in healthcare provider configuration or a similar role.
Strong knowledge of Facets or similar health insurance systems.
Understanding of medical terminology, healthcare plan benefits, pricing, and the ability to apply complex healthcare rules and company policies.
Proficient in SQL for data extraction and analysis.
Proficient in Microsoft Office, especially Excel, including advanced functions, pivot tables, macros, and data modeling.
Experience with data visualization tools.
Excellent attention to detail and strong analytical skills, with the ability to analyze large data sets, approach problems from multiple angles, and draw meaningful conclusions.
Experience with quality assurance methods, including designing and implementing QA processes.
Strong written and verbal communication skills; skilled at creating clear reports and presentations for both technical and non-technical audiences.
Strong critical thinking skills focused on process improvement and turning complex data findings into actionable insights.
Ability to work independently and collaboratively within a remote team.
Excellent time management and organizational skills.
Ability to handle confidential information with care.
Maintain a professional appearance and demeanor in all internal and external interactions.

Responsibilities

Audit provider configuration work using various tools, including SQL, to validate complex data.
Create and maintain Excel models to compare data, identify trends, and detect issues.
Analyze quality and compliance data using Excel and SQL and produce detailed reports.
Design and implement solutions that address quality issues in the Provider Configuration department.
Create dashboards and reports using Excel and SQL to track performance and quality metrics.
Analyze provider information, contract details, and pricing using SQL and Excel pivot tables.
Collaborate with IT and other departments to develop strong data validation processes.
Provide data-driven insights to leadership and constructive feedback to analysts for improvement.
Maintain a library of SQL queries and Excel templates for common audit tasks.
Use complex data analysis to inform decisions about process improvements.
Perform other duties as assigned.