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.

Job Summary:
Responsible for ongoing oversight of delegated agreements and entities. Maintains the integrity of the delegates credentialing departments processes in according with Moda policies, National Committee for Quality Assurance (NCQA), and Centers for Medicaid & Medicare Services (CMS) standards and state and federal requirements.​​​​​
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=27731079&refresh=true

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

Required Skills, Experience & Education:

• Bachelor’s degree or equivalent specializing in health or business. 
• 2+ years’ experience working in a health plan or similar organization.  Provider credential experience preferred.
• Type a minimum of 50 wpm on computer keyboard.
• Ten key proficiency of 135 kspm net.
• Strong organizational and time management skills.
• Ability to work well under pressure, meet deadlines, produce a high volume of  work and work independently as well as in a team environment, with shifting priorities.
• Ability to problem solve, retain information and have strong attention to detail.
• Proficient in Microsoft Office applications with the ability to learn internal computer systems.  Working knowledge of crystal reports desired.
• Working knowledge of NCQA, the Centers for Medicare and Medicaid Services and Oregon Health Authority or other state credentialing standards helpful.
• Excellent verbal, written and interpersonal skills.
• Ability to maintain confidentiality and project a professional business image.
• Ability to come in to work on time and on a daily basis.

Primary Functions:

• Performs annual oversight audits for all Moda delegates, which includes, but is not limited to policy & procedure review and file sample audits.
• Collection and tracking of bi-annual reports from delegates.
• Implementation of correction action plans as needed.
• Ensuring all delegated entities are on current and compliant agreements.
• Ongoing maintenance of audit tools and documentation.
• Ongoing communication with delegated entity contacts.
• Reports audit findings, including any non-compliance or credentialing issues to the credentialing supervisor.
• Ensures oversight of delegate data accuracy and timeliness.
• Assures confidentiality of documents, records, and data information. Keeps all documents secure and confidential.
• Performs other duties as assigned.

Contact with others & Working Conditions

• Internally with all departments.  Externally with vendors, providers, health professionals and physician offices, IPA, Delegates, Rented Networks, Hospitals and Licensing boards.
• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. May work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.

Together, we can be more. We can be better.
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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.