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 Provider Relations expertise and process oversight to Medical Provider Representatives.  Ensure consistency of process across provider teams.  Support Team Manager in growth and development of staff, including workflow processes, training programs, and policy and procedure development.  Represent the team as the lead on various projects and committees. Cultivate and maintain professional relationships with providers and practices in assigned territories. This is a FT WFH role. 


Pay Range
$64,394.27 - $80,498.01 annually, DOE.
*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=27765484&refresh=true



Benefits:

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

Required Skills, Experience & Education:

1. College degree or equivalent work experience.
2. At least 3 years’ experience meeting and/or exceeding requirements as a Medical Provider Relations Representative II.
3. Possess exceptional analytical problem solving and detail orientation skills.
4. Demonstrated leadership ability with training, policy, and procedure development and/or UPM development experience strongly preferred.
5. Ability to instruct, motivate, direct individuals at various skill levels over the phone, face to face and in the classroom environment. Ability to shift presentation of training topics to accommodate different learning styles.
6. Strong knowledge of Moda systems including Facets as they relate to Claims and Customer Service.
7. PC proficiency with all Microsoft Office applications, specifically PowerPoint and Excel.
8. Strong verbal, written, and interpersonal communication skills including conflict management.
9. Maintain confidentiality and project a professional business appearance. 

Primary Functions:

1. Own and maintain relationships with contracted providers in assigned territories, particular focus with strategic regional partners and VBC-participating providers.
2. 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 policies. All providers should be provided with an invitation for such visits. There should be a minimum of 5-8 visits on average per month.
3. Project manage the Provider Workshop events held annually each fall. This includes content coordination, staff assignments, resource booking, and delivery of presentation. Per
4. Performs direct supervision to a team of 2-6 provider relations professionals. This includes formal performance evaluation, meeting at regular intervals to ensure proper communication is occurring, and giving coaching as appropriate.
5. Outreach to providers for various initiatives including special projects, policy changes, information requested from internal departments, etc.
6. Participate in ongoing Moda committees with the expectation of providing feedback and recommendations from the Provider Relations perspective while bringing back pertinent information to the entire team. As necessary, act as the sole departmental representative on cross-departmental initiative, with broad, effective knowledge of all aspects of department functions.
7. Monitor workflow processes and develop procedures to ensure efficiency, accuracy, and accountability.
8. Assist staff in problem solving and resolution and acts as primary contact for long-term and day-to-day training needs.
9. Coordinate and maintain development of Medical PR policies and procedures, including publishing on Insider.
10. Collaborate with other teams, peers, and management to identify areas of inefficiency and process improvement opportunities.
11. Perform other duties as assigned.

Working Conditions & Contact with Others:

• Office environment with extensive close PC and keyboard work, constant sitting, and phone use. Local appointments, meetings and social events, and extensive travel throughout the Moda region (20-30% of time). Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
• Externally with contracted medical providers, clinic administrators, hospital executives, billing staff and IPA administrators. Internally with Claims, Customer Service, Marketing, Healthcare Services, Sales and Services, Compliance, Credentialing, Appeals, Medical Provider Configuration, Benefit Configuration, EDI, Accounting. Represent Moda at external venues.

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

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