Job Description

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
This position is responsible for timely, accurate data entry and maintenance of Medical and Dental member eligibility, member and billing reconciliation, customer service to assigned groups or accounts, and generation of ID cards for all Moda Health and BHS lines of business including; Individual, Medicare, Medicaid, (CCO and DCO) and Employer Group customers of all sizes (ASO and Fully insured) COBRA and TPA accounts. This is a full-time hybrid position based in Portland, Oregon.
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Pay Range
$18.03- $20.18 hourly, DOE.
*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=27766506&refresh=true
Benefits: * Medical, Dental, Pharmacy, and Vision Coverage

• 401K
• FSA
• PTO and Paid Holidays

Required Skills, Experience, & Education: * High school diploma or equivalent.

• Previous experience and/or knowledge of Facets preferred.
• A minimum of 3 years' experience preferred in fast paced business, data entry, customer service, enrollment, billing, and reconciliation environment.
• Computer proficiency with Microsoft Office applications particularly Excel and Word.
• Ten key proficiency of 135 kpm on a computer numeric keypad/calculator preferred.
• Typing proficiency of 25 wpm preferred.
• Strong analytical, problem solving, decision making, organizational and detail-oriented skills.
• Strong verbal, written and interpersonal communication skills.
• Ability to be courteous, patient and communicate with Moda Health and BHS members, Moda Health and BHS employees and Employer Groups in a positive and productive manner.
• Maintain confidentiality and project a professional business image.

Primary Functions: * Responsible for eligibility and enrollment procedures daily via paper enrollment, electronic file, web-based transactions, email enrollments, and sending welcome packet to our new members for all Moda and BHS products and lines of business.

• Ensure the accuracy and timeliness of entering enrollments within the department, Employer Groups, State and Federal standards depending on Product and Line of Business.
• Responsible for following delinquency policy and procedures to ensure both compliance and timely receipt of administrative fees and premiums.
• Ensures all member, premium and administrative fees are reconciled monthly to the penny.
• Maintains confidentiality of all information related to members, employer groups, employees, and as appropriate, other information.
• Highly motivated and able to take initiative, demonstrated ability to identify and solve problems.
• Responds to all internal and external customer inquiries regarding enrollments, ID cards and attends customer meetings as requested by Sales and Account Services.
• Responsible to log and track enrollment applications in excel and give monthly reports to the Supervisor and the groups that shows a running balance on total enrollments received; enrollments entered into our system; voids and pending.
• Accurately enter COB, COBRA and Pre-Existing for timely and accurate claims adjudication as well as sending out required COBRA notifications.
• Requests and verifies the issuance and accuracy of member ID cards.
• Keeping track of supplies and ordering when necessary.
• Process Return Mail.
• Adhere to and enforces group contract, State and Federal guidelines regarding eligibility standards and requirements.
• Be a supportive and collaborative teammate.
• Performs other duties and projects as assigned.

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

Skills Required