Credentialing Coordinator - Internal Applicants Only

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 leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process in accordance with Moda policies, National Committee for Quality Assurance (NCQA) standards and state and federal requirements. This is a FT hybrid position based in Portland, Oregon.

Pay Range

$22.88 - $25.74 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=27763295&refresh=true

Benefits

• 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 oversight of credentialing delegates to ensure compliance with our oversight bodies.
• Generating and distributing credentialing reports.
• Identifies and reports any non-compliance or credentialing issues to the credentialing supervisor.
• Monthly monitoring of provider license action and sanction information.
• Assures confidentiality of documents, records and data information. Keeps all documents secure and confidential.
• Collection of needed verification from all relevant licensing bodies.
• Approved application process and reporting.
• 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.

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.

#INTONLY