Operations Data Analyst II

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

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)

• 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=27771927&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 required and master’s degree preferred in Data Analytics, Mathematics, Computer Science, Finance, or related quantitative fields.
• Minimum of 2 years of experience with healthcare billing and claims data.
• Advanced statistical, analytical, and problem-solving skills with the ability to work with complex data.
• 5 years of experience using data analysis tools such as SAS, MS SQL, MS Access, decision support systems, or other business intelligence tools.
• Advanced proficiency in MS Excel and other MS Office products.
• Effective written and verbal communication.
• Ability to work well under pressure and with shifting priorities.
• Maintain confidentiality and project a professional business image.
  
  

Primary Functions

• Create and analyze complex healthcare utilization reports under limited supervision using relational databases, Excel, and Tableau to support multiple departments.
• 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.
• Audit vendor and provider contracts and reimbursement policies to ensure correct payments and translate audit findings into financial impacts.
• Identify cost-saving opportunities by optimizing reimbursement methodologies and configuration, automating processes, and improving operational efficiency.
• Collaborate with various departments to implement new programs and policies for claims savings and process improvement.
• Build and maintain complex reporting required for government and regulatory compliance.
• Develop and maintain pricing tools to support accurate adjudication of complex claims.
• Manage large audit projects, including facilitating work groups and presenting findings.
• Assist department staff with technical functions including the manipulation and interpretation of large data sets.
• Conduct ad hoc analysis for departmental leadership.
• Perform other duties as assigned.
  
  

Working Conditions

• 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.
• Internally with Claims, Configuration, Customer Service, SIU, Data Science, Compliance, Account Services, Medicaid and Provider Relations. Externally with vendors, healthcare providers and government staff.
  
  

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.