Qureos Mentor

Moda Health

<div>
 
 Let&rsquo;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&rsquo;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&rsquo;s be better together.
 
 
 
 Position Summary
 
 
 
 The Operations Data Analyst II supports the Claims department by analyzing medical and pharmacy claims, provider, membership, and enrollment data. Functions include auditing contract performance, reviewing policies and procedures, building reports for audit teams, supporting clinical editing operations, and providing technical assistance and ad hoc analysis for various departments. Some tasks are routine while others evolve with organizational needs, offering opportunities to learn and improve processes. The position allows for creative problem-solving and encourages the analyst to utilize their knowledge, experience, and ideas to enhance deliverables.
 
 This is a FT WFH position.
 
 
 
 
 Pay Range
 
 
 
 $78,911.43 - $98,639.28 annually (depending on experience)
 
 
 <ul>
 <li>
 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.
 
 
 </li>
 </ul>
 
 Please fill out an application on our company page, linked below, to be considered for this position.
 
 
 
 https://j.brt.mv/jb.do?reqGK=27771927&amp;refresh=true
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Medical, Dental, Vision, Pharmacy, Life, &amp; Disability
 </li>
 <li>
 401K- Matching
 </li>
 <li>
 FSA
 </li>
 <li>
 Employee Assistance Program
 </li>
 <li>
 PTO and Company Paid Holidays
 
 
 </li>
 </ul>
 
 Required Skills, Experience &amp; Education
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree required and master&rsquo;s degree preferred in Data Analytics, Mathematics, Computer Science, Finance, or related quantitative fields.
 </li>
 <li>
 Minimum of 2 years of experience with healthcare billing and claims data.
 </li>
 <li>
 Advanced statistical, analytical, and problem-solving skills with the ability to work with complex data.
 </li>
 <li>
 5 years of experience using data analysis tools such as SAS, MS SQL, MS Access, decision support systems, or other business intelligence tools.
 </li>
 <li>
 Advanced proficiency in MS Excel and other MS Office products.
 </li>
 <li>
 Effective written and verbal communication.
 </li>
 <li>
 Ability to work well under pressure and with shifting priorities.
 </li>
 <li>
 Maintain confidentiality and project a professional business image.
 
 
 </li>
 </ul>
 
 Primary Functions
 
 
 
 <ul>
 <li>
 Create and analyze complex healthcare utilization reports under limited supervision using relational databases, Excel, and Tableau to support multiple departments.
 </li>
 <li>
 Evaluate the impact of reimbursement methodologies for medical claims using data models built in SAS, MS SQL, and Excel. Methodologies include CMS based (RBRVS, DRG, ASC), per diem, percentage of charge, and capitation.
 </li>
 <li>
 Audit vendor and provider contracts and reimbursement policies to ensure correct payments and translate audit findings into financial impacts.
 </li>
 <li>
 Identify cost-saving opportunities by optimizing reimbursement methodologies and configuration, automating processes, and improving operational efficiency.
 </li>
 <li>
 Collaborate with various departments to implement new programs and policies for claims savings and process improvement.
 </li>
 <li>
 Build and maintain complex reporting required for government and regulatory compliance.
 </li>
 <li>
 Develop and maintain pricing tools to support accurate adjudication of complex claims.
 </li>
 <li>
 Manage large audit projects, including facilitating work groups and presenting findings.
 </li>
 <li>
 Assist department staff with technical functions including the manipulation and interpretation of large data sets.
 </li>
 <li>
 Conduct ad hoc analysis for departmental leadership.
 </li>
 <li>
 Perform other duties as assigned.
 
 
 </li>
 </ul>
 
 Working Conditions
 
 
 
 <ul>
 <li>
 Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
 </li>
 <li>
 Internally with Claims, Configuration, Customer Service, SIU, Data Science, Compliance, Account Services, Medicaid and Provider Relations. Externally with vendors, healthcare providers and government staff.
 
 
 </li>
 </ul>
 
 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 &amp; Danielle Baker via our humanresources@modahealth.com email.
</div>

Operations Data Analyst II

<div>Let&rsquo;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&rsquo;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&rsquo;s be better together. 
 
Position Summary 
Receive, track, sort, prepare, and route all incoming mail to various departments. Operate and maintain office equipment, including Opex, Omation, and multiple scanners. Prepare batches for in-house scanning or external processing with Symbeo while maintaining strict turnaround times. Enter member, group and provider information into the system for processing. Prepare daily inventory reports and assist with training on rotational tasks when necessary. Provide coverage for the receptionist desk and phone when required. This is a FT hybrid position based in Milwaukie, Oregon. 
Pay Range 
$17 - $17.50 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=27768549&amp;refresh=true 
Benefits:<ul><li>
Medical, Dental, Vision, Pharmacy, Life, &amp; Disability</li><li>
401K- Matching</li><li>
FSA</li><li>
Employee Assistance Program</li><li>
PTO and Company Paid Holidays</li></ul> 
Schedule:<ul><li>
Flexible schedule 8 am - 5 pm</li></ul>
Location:<ul><li>
10505 SE 17th Ave, Portland, OR 97222</li></ul>
Requirements:<ul><li>
High school diploma or equivalent.</li><li>
At least 6-12 months experience in a production environment preferred.</li><li>
Ability to lift 20+ pounds and work in a fast-paced, physical role.
</li><li>Ability to embrace process improvements and work well in a team-oriented environment.</li><li>
Proficiency with Microsoft Office applications.</li><li>
Typing ability of 35 wpm.</li><li>
10-key proficiency of 135 kspm.</li><li>
Proficient with prioritizing tasks and completing them with high accuracy and speed.
</li><li>Ability to work well under pressure, with frequent interruptions and shifting priorities.</li><li>
Demonstrates effective reading, writing and oral communication skills.</li><li>
Ability to meet production and quality standards for various types of work and documents.</li><li>
Skilled in handling multiple tasks.</li></ul> 
Primary Functions:<ul><li>
Handle all incoming mail, including inter-office, packages, letters, claims, and certified mail.</li><li>
Sort and prepare medical and dental claims for scanning and vendor handling.</li><li>
Locate, store, rescan, return, or forward claims for further review.</li><li>
Scan paper x-rays.</li><li>
Lift and pull stacks of claims, bins, and mail trays.</li><li>
Track outgoing and incoming claims batches between Moda and Symbeo to ensure compliance and all records are accurate and accounted for.</li><li>
Ensure timely processing of all mail, including scanning, batching, and indexing. Prioritize Medicaid, Medicare, and appeal-related mail to maintain compliance with federal and state regulations.
</li><li>Prepare and batch specialized sorting tasks like medical correspondence, member appeals, and prescription claims.</li><li>
Prepare and distribute daily inventory to Claims Management teams.</li><li>
Keep the mail distribution area clean and organized.</li><li>
Maintain office equipment, including Omation and Opex automatic mail-opening machines and multiple scanners.</li><li>
Enter claims data accurately using Moda systems and ensuring correct member and provider selection while reassigning claims based on dental claims processing guidelines.
</li><li>May write and mail letters to members and providers.</li><li>
Provide relief coverage for the reception desk.</li><li>
Perform other duties as assigned.</li></ul> 

Contact with Others 
Internally with various departments. Externally with members, providers, brokers, etc., when covering reception desk. 
 
Working Conditions 
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need. 
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 &amp; Danielle Baker via our humanresources@modahealth.com email.</div>

Imaging Data Entry Clerk

<div>Let&rsquo;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&rsquo;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&rsquo;s be better together. 
Position Summary 
The Senior Data Science BSA gathers and documents business requirements related to the Enterprise Data Warehouse (EDW), including processes, system flows, and functional designs for break fixes, upgrades, vendor implementations, and product enhancements. This position analyzes existing systems, designs new systems, and evaluates requirements and specifications throughout the software development lifecycle, including testing and implementation for projects with significant departmental or organizational impact. This is a FT WFH position.<div> 
Pay Range 
$91,528.82 - $119,013.51 annually (depending on experience) 
<ul><li>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.</li></ul></div> 
Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27769233&amp;refresh=true 
Benefits:<ul><li>
Medical, Dental, Vision, Pharmacy, Life, &amp; Disability</li><li>
401K- Matching</li><li>
FSA</li><li>
Employee Assistance Program</li><li>
PTO and Company Paid Holidays</li></ul> 
Required Skills, Experience &amp; Education:<ul><li>
8+ years of experience in technical or business analysis, including at least 5 years as a Business Systems Analyst, Experience with data teams or data warehouses and familiarity with health insurance administration or clinical/operational healthcare preferred.</li><li>
Experience building and/or maintaining data dictionaries with demonstrated procedural and technical writing skills required.</li><li>
2+ years of experience supporting analytical and reporting use-cases involving large datasets and/or data warehouses.</li><li>
Ability to read, write and execute SQL statements.</li><li>
Experience with SQL Server and cloud-based data warehouses such as Snowflake, Microsoft Synapse/Fabric, BigQuery, Redshift, or Databricks preferred.</li><li>
Expert facilitation skills for both large and small group meetings or working sessions.</li><li>
Effective verbal and written communication skills with internal and external partners and stakeholders of varying technical skill levels.</li><li>
Proven critical thinking, time management, and problem-solving skills.</li><li>
Ability to work collaboratively in a production support team and independently with minimal supervision.</li><li>
Ability to work well under pressure in a fast-paced environment with frequent interruptions and shifting priorities while managing multiple assignments.</li><li>
Strong organizational skills with the ability to plan, prioritize, and meet deadlines.</li><li>
Ability to work with at least one additional language on top of SQL, such as SAS, R, or Python a plus.</li><li>
Familiarity with modern data transformation tools such as dbt or Coalesce nice to have.</li></ul> 
Primary Functions:<ul><li>
Model best practice requirements engineering for all aspects of development lifecycle activities including elicitation, analysis, and prioritization of functional and non-functional requirements.</li><li>
Mentor and support junior analysts to ensure alignment with enterprise architecture and strategic objectives.</li><li>
Partner with business and technical leadership to define, validate, and approve detailed functional specifications and acceptance criteria for high-impact initiatives.</li><li>
Proactively identify and source potential Data Science projects based on organizational priorities and EDW capabilities.</li><li>
Author and review technical documentation for enterprise-level systems ensuring compliance with Data Science standards and influencing documentation best practices.</li><li>
Lead the development of business cases, contingency plans, business metrics and measurements, process models, training materials, new procedures, test scripts, ad-hoc reports, and smart solutioning for process improvements.</li><li>
Participate in the review and approval of system designs, logical data designs, report designs, interface designs, and conversion plans. Review and approve high-level data flows, functional specifications, and implementation plans. Suggest design alternatives as appropriate.</li><li>
Develop, document, and implement test plans, scenarios, and outcomes following Data Science standards to ensure stakeholder requirements are met.</li><li>
Perform post-implementation quality assurance and troubleshooting ensuring adequate documentation following department standards.</li><li>
Coordinate and collaborate with IT and Corporate project managers on projects involving the EDW.</li><li>
Provide training and communicate system changes to end-users and other impacted staff.</li><li>
Perform ongoing production support, scope bug fixes, and ensure resolution of complex issues for critical data-related applications to minimize business disruption.</li><li>
Perform other duties as assigned.</li></ul> 
Working Conditions:<ul><li>
Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need. Must be able to adjust schedule to accommodate production support needs, project schedules and peak work periods.</li><li>
Internally with all levels of Moda personnel and business units. Externally with vendors, consultants, and contractors.</li></ul> 
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 &amp; Danielle Baker via our humanresources@modahealth.com email.</div>

Sr Data Science Business Systems Analyst

Join Moda Health and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Moda Health

About Company

Operations Data Analyst II

Imaging Data Entry Clerk

Sr Data Science Business Systems Analyst