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 
This limited-duration, grant-funded position supports the EOCCO Health Related Social Needs (HRSN) Operations team by coordinating housing-related benefits and providing direct navigation services to Medicaid members. Primary responsibilities include authorizing housing, utility, and tenancy support benefits, and guiding members through post-service navigation. Additional duties may include support for climate benefit, home modification, and home remediation authorizations. 
 
This position fulfills contractual obligations with the Oregon Health Authority (OHA) ensuring collaboration between health plans and community partners in overseeing the utilization of services by all members, particularly those that make up the prioritized populations identified in various Oregon Administrative Rulings.
 
This is a temporary, limited duration position that is expected to conclude on September 30, 2027. This role is a hybrid based in Portland, Oregon. 
 
Pay Range<div>
$53,591.76 - $62,000 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=27773668&amp;refresh=true 
Benefits:<ul><li>
Medical, Dental, Vision &amp; Pharmacy</li><li>
PTO and Company Paid Holidays</li><li>
401k - Matching</li></ul> 
Required Skills, Experience &amp; Education:<ul><li>
2+ years of experience in healthcare, public health, member navigation, or community-based organizations, with rural or underserved communities.</li><li>
Traditional Health Worker (THW) certification preferred, or willing to obtain within 6 months of hire.</li><li>
Strong understanding of HRSN and Medicaid complexities.</li><li>
Familiarity with Oregon&rsquo;s housing landscape including HUD, Section 8, and other housing resources.</li><li>
Experience in a medical office, social work, case management, or utilization management preferred.</li><li>
Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint).</li><li>
Ability to type at least 60 wpm net.</li><li>
Excellent oral, written, and interpersonal communication skills.</li><li>
Experience communicating with members and providers via phone, email, and written correspondence.</li><li>
Ability to advocate for member needs and contribute to process improvements.</li><li>
Strong analytical, organizational, and problem-solving skills.</li><li>
High attention to detail and ability to meet deadlines.</li><li>
Ability to work under pressure in a complex and rapidly changing environment.</li><li>
Ability to maintain confidentiality and the organization professionally in the community.</li></ul> 
Primary Functions:<ul><li>
Conduct eligibility screenings for HRSN benefit requests, including outreach to members, providers, and other entities.</li><li>
Provide outreach and engagement to members presumed eligible for the HRSN housing benefit.</li><li>
Deliver housing navigation services throughout the duration of member&rsquo;s benefit authorization.</li><li>
Offer additional outreach to members as needed to provide support services or connect them to other resources.</li><li>
Educate members and providers on HRSN services, including eligibility criteria, coverage, and available resources.</li><li>
Partner with landlords, property managers, and utility companies to facilitate benefit delivery and provide education.</li><li>
Collaborate with the HRSN Manager or RN on complex cases.</li><li>
Coordinate benefit ordering and track items approved through HRSN benefits.</li><li>
Initiate and manage payments for approved services (rent, utilities) via check request or online payment.</li><li>
Prepare and send required correspondence to members, providers, and internal departments to identify support persons and notify EOCCO-designated care coordination staff.</li><li>
Complete documentation to support compliance deliverables and reporting throughout the year.</li><li>
Maintain accurate documentation of all member and provider interactions in core systems.</li><li>
Provide data entry and tracking for HRSN program metrics and reporting.</li><li>
Utilize internal systems (CCA, Facets, benefit tracker) for eligibility and benefit verification.</li><li>
Ensure adherence to HIPPA and other regulatory guidelines, including privacy and security.</li><li>
Maintain a 98% quality audit score for care planning documentation.</li><li>
Identify and troubleshoot issues related to benefit delivery or member support.</li><li>
Collaborate with internal teams to ensure coordinated care to meet member needs.</li><li>
Remain current on all Oregon Health Authority guidance regarding HRSN benefits.</li><li>
Perform other duties as assigned.</li></ul> 
Working Conditions &amp; Contact with Others:<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 Healthcare Services, Case Management, Claims and other various departments. Externally with members, HRSN service providers, property managers, utilities companies, community-based organizations, and other health systems across service area.</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 and Danielle Baker via our humanresources@modahealth.com email.</div>

Social Health Housing Benefit Coordinator -Temporary

<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 
Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims. Answer internal questions from various departments and respond to correspondence from providers when necessary. This is a FT WFH role. 
 
Pay Range 
$21.30 - $23.96 hourly (depending on experience) *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=27772651&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>
High School diploma or equivalent.</li><li>
1-2 years medical claims processing experience.</li><li>
10-key proficiency of 135 wpm.</li><li>
Type a minimum of 35 wpm.</li><li>
Knowledge of medical terminology, CPT codes and ICD-10 codes.</li><li>
Strong verbal, written, and interpersonal communication skills.</li><li>
Analytical, problem solving and organizational skills.</li><li>
Ability to work well under pressure.</li><li>
Maintain confidentiality and project a professional business image</li><li>
Ability to maintain balanced performance in areas of production and quality.</li></ul> 
Primary Functions:<ul><li>
Review, process and adjust Commercial and Medicaid inpatient claims.
</li><li>Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.</li><li>
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
</li><li>Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS).
</li><li>Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
</li><li>Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
</li><li>Contact providers and other outside sources for additional information.</li><li>
Adjudicate claims to achieve quality and production standards applicable to the position.</li><li>
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.</li><li>
Review Policy and Procedures (P&amp;P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.</li><li>
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.</li><li>
Perform other duties as assigned.</li></ul> 
Working Conditions &amp; Contact with Others<ul><li>
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 37.5 hours per week, including evenings and occasional weekends, to meet business need.</li><li>
Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.</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 and Danielle Baker via our humanresources@modahealth.com email.</div>

Inpatient Claims Processor I

Join Moda Health and explore 2   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

Social Health Housing Benefit Coordinator -Temporary

Inpatient Claims Processor I