Post job

Moda Health jobs - 434 jobs

  • Medical Claims Entry Operator

    Moda Health 4.5company rating

    Moda Health job in Milwaukie, OR

    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 Enters the processing system all claims received by mail or route claims as directed to processing specific data entry queues. Interrogates data on claims received electronically where member or provider information does not match Moda records. This is a FT WFH role. Pay Range $17.00- $18.55 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. ************************** GK=27769227&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: High school diploma or equivalent. Six months data entry experience. 10-key proficiency of 135 spm net on a computer numeric keypad. Typing ability of 35 wpm net. Proficiency with Microsoft Office applications and an understanding of basic claims processing rules. Strong problem solving and detail orientation skills. Medical terminology helpful. Ability to adapt to frequent changes in instructions. Ability to come into work on time and on a daily basis. Maintain confidentiality and project a professional business image. Primary Functions: Data enters claims accurately using Moda computer systems. Reassigns claims appropriately as outlined by Medical Claims processing guidelines. Resolves claims that pend with errors in the processing system by matching claims received to Moda providers or member records. Research and problem solve basic claims data. Identifies and communicates trends. Performs other duties as assigned. Working Conditions & Contact with Others 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. Internally with Membership Accounting, Medical Claims, and Professional Relations. 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 ***************************** email.
    $17-18.6 hourly 12d ago
  • Job icon imageJob icon image 2

    Looking for a job?

    Let Zippia find it for you.

  • Health Promotion & Wellness Consultant

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 The Health Promotion and Wellness Consultant will partner with Moda Health's employer groups to consult on high-impact workplace wellness program. The Consultant will identify key strategies to build wellness into company cultures and to maximize employee engagement in workplace wellness programs. Some human capital initiatives include health assessments, health education presentations, interest surveys, needs assessments, and connections to Moda Health and vendor resources - all of which support our clients' organizational health and wellness efforts. This is a FT hybrid position based in Portland, Oregon. Pay Range $48,900.76 - $61,125.95 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. ************************** GK=27768547&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 and two years of experience in wellness, public health, health promotion, health coaching or healthcare preferred. Strong customer service, written & verbal communication skills. Ability to work independently and collaboratively with a team. Thorough knowledge and understanding of health behavior change theory and workplace environmental applications. Strong organizational, time-management, and problem-solving skills, with high attention to detail. Proficiency in Microsoft Word, Excel, Outlook, and Access (data entry forms). Ability to learn proprietary databases. Valid Oregon driver's license. Ability to handle a pushcart/hand truck and to lift boxes up to 40 lbs. in and out of a car trunk. Ability to maintain confidentiality and project a professional business image telephonically and in person. Primary Functions: Serves as the wellness program expert, working with groups to design, implement and evaluate worksite wellness programming, based on Moda's suite of population health and wellness programs. Serves as a liaison between the groups contact and the wellness product, providing ongoing follow up, responding to questions regarding program operations and resolving any issues. Provides basic interpretation of aggregate health risk assessment data, review of utilization reports, discussion of resources. Conducts wellness and health promotion presentations to members and employees, as needed. Works closely with group contacts to coordinate employer-based wellness activities (e.g. biometric screenings, health fairs, and activity incentives) and evaluate program impact. Contributes to the selection, development, implementation, and evaluation of educational materials and other member communications. Reviews and maintains a suite of materials; works with supervisor to identify and request additional resources, as needed. Develops and maintains effective and productive relationships with clients, prospects, vendors, and other Moda Health departments. Perform other duties as assigned. Working Conditions & Contact with Others: 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 multiple departments. Externally with clients and vendors. 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 ***************************** email.
    $48.9k-61.1k yearly Easy Apply 30d ago
  • RN - LVAD Cardiac Transplant

    Providence Health and Services 4.2company rating

    Portland, OR job

    RN - LVAD Cardiac Transplant Unit at Providence St. Vincent Medical Center. This posting represents a .9 FTE, night shift opening (7pm-7:30am, 3, 12 hour shifts per week) with rotating weekends. Extra Incentives: Night shift differential - $10.00 p/hr $6,000 hiring bonus and relocation assistance offered for eligible external hires that meet required qualifications and conditions for payment. Providence offers a fantastic benefits package which include but is not limited to: Free, convenient, and ample parking TriMet annual pass (Hop Fastpass) for benefit eligible staff who work within the Portland Service Area (does NOT include Wilsonville, Newberg, Seaside, Hood River, Washington State, or Medford) Medical Plan Assistance Program- provides free or reduced-cost coverage to caregivers and their eligible dependents who qualify based on household size and income Tuition reimbursement/education- includes 100% tuition paid program options; up to $5,250 per year for select undergraduate and masters degrees within Guild catalog. Required books and fees are 100% covered or reimbursable for select schools in the Guild catalog up to program funding cap Paid Time Off - Benefit eligible caregivers receive generous PTO accrual allowances Retirement - The Providence retirement program consists of employer match and discretionary contributions that work together with your pre-tax (and/or Roth aftertax) contributions to help you save for retirement. Lyra Caregiver Assistance program- Up to 25 counseling or coaching sessions per eligible member per year Providence nurses are not simply valued - they're invaluable. You will thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best nurses, we must empower them. Learn why nurses choose to work at Providence by visiting our Nursing Institute page. Join our team at Providence St Vincent Medical Center. As a Providence caregiver, you'll apply your specialized training to deliver world-class health with human connection and make a difference every day through your extraordinary care. Required Qualifications: Graduation from an accredited nursing program. Oregon Registered Nurse License upon hire. National Provider BLS - American Heart Association upon hire. National Provider ACLS - American Heart Association within 90 days of hire 1 year nursing experience. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence has been serving the Pacific Northwest since 1856 when Mother Joseph of the Sacred Heart and four other Sisters of Providence arrived in Vancouver, Washington Territory. As the largest healthcare system and largest private employer in Oregon, Providence is located in areas ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 408278 Company: Providence Jobs Job Category: Nursing-Patient Facing Job Function: Nursing Job Schedule: Full time Job Shift: Multiple shifts available Career Track: Nursing Department: 5002 PSVMC CARDIOLOGY B 8E Address: OR Portland 9205 SW Barnes Rd Work Location: Providence St Vincent Medical Ctr-Portland Workplace Type: On-site Pay Range: $55.10 - $77.43 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. PandoLogic. Category:Healthcare, Keywords:Cardiac Nurse, Location:Portland, OR-97204
    $24k-92k yearly est. 4d ago
  • Director of Underwriting

    Providence Health & Services 4.2company rating

    Portland, OR job

    Calling all Esteemed Leaders! Are you a strategic mastermind with a passion for healthcare? Do you thrive on navigating complex challenges and shaping the future of healthcare delivery? If so, then we have the perfect opportunity for you! You can be based in Oregon, Washington or California. The Role: As the Director of Underwriting for Providence Health Plans, you will be a pivotal force in developing strategies and policies to support profitable membership growth, retention, business expansion, and diversification in accordance with long-range plans. You will provide clear vision, direction, and consistency in risk analysis, planning, organizing, developing, implementing, evaluating, and auditing underwriting activities and models across all regions. You will identify risks related to the introduction of new products or modification of underwriting requirements and represent the Plan alongside Sales to promote pricing transparency to Producer partners and employer groups, substantiating and providing credibility around pricing decisions. What You'll Do: + Strategic Architect: Collaborate with Plan leaders to create and implement strategies and policies that support product development efforts, profitable growth, special risk arrangements, business expansion, and diversification according to the long-range plan for fully insured commercial business. + Performance Guide: Lead development, monitoring, and achievement of department service level standards, fostering high-performance relationships with Sales, Pharmacy, Product, and Actuarial departments. + Underwriting Leader: Direct all rating and underwriting activities for all new and renewing fully insured large group and Association Health Plan commercial group lines of business, ensuring financial performance and development of associated pricing models. + Transparency Advocate: Represent the Plan alongside Sales Leadership, promoting pricing transparency to Producer partners and employer groups, substantiating and providing credibility around pricing decisions. + Compliance Champion: Ensure adherence to underwriting audits, processes, guidelines, and procedures consistent with State and Federal Law and regulatory requirements. + Collaborative Innovator: Work with Actuarial and Finance Directors to routinely update and test rates and factors in the underwriting models, ensuring alignment with industry best practices and strategic objectives. + Talent Developer: Mentor and coach the Underwriting Manager and staff, attracting top industry underwriting talent and fostering development and engagement within established authority levels. + Budget Strategist: Oversee the development and achievement of the Underwriting Department's annual budget. What You'll Bring: + Educational Background: Bachelor's Degree in Finance, Mathematics, or a related field; Master's Degree in Business Administration preferred. + Experience: 10 or more years of experience in healthcare underwriting, with 5 years in a Leadership role and 2 years leading teams through promoting teamwork, decision-making, delegation, training, and coaching. + Analytical Expertise: Exceptional quantitative and problem-solving skills, with a thorough understanding of insurance underwriting and rating methodologies. + Strategic Mindset: Ability to work with senior management to quickly solve difficult strategic questions. + Technical Proficiency: Strong skills in spreadsheet, statistical, and database software packages. + Communication Mastery: Excellent written, verbal, listening, negotiation, presentation, and math skills. + Project Management Skills: Ability to maintain positive relationships with critical areas while achieving department objectives. Why Join Us? + Make a Real Difference: Be part of an organization that transforms healthcare and improves countless lives. + Unleash Your Potential: Enjoy the autonomy and support needed to bring innovative ideas to life. + Work with the Best: Collaborate with a team of talented and dedicated professionals passionate about their work. + Thrive in a Dynamic Environment: Embrace the challenges and rewards of a fast-paced, ever-evolving industry. Ready to Shape the Future of Healthcare? If you're a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Requsition ID: 394481 Company: Providence Jobs Job Category: Underwriting Job Function: Finance Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 5018 SALES UNDERWRITING OR REGION Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: Remote Pay Range: $76.29 - $121.96 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
    $76.3-122 hourly Auto-Apply 60d+ ago
  • Medicaid Strategic Operations Supervisor

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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: The Strategic Operations Supervisor oversees the planning and execution of strategic Medicaid initiatives and innovations. This role manages escalated issues, monitors performance, identifies cost-saving opportunities, and leads fiscal and budgetary planning. The Supervisor ensures compliance with federal, state, and contractual requirements; identifies and mitigates operational risks; and supports the quality, efficiency, and integrity of Medicaid program operations. This is a full-time hybrid position based in Portland, Oregon. Pay Range $70,579.27 - $88,224.08 (annually) 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. ************************** GK=27761354&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Primary Functions: Lead Medicaid cost-saving initiatives by analyzing, recommending, implementing, and tracking outcomes across internal departments and external entities. Develop and maintain departmental and executive dashboards and performance metrics, including identifying measurable KPIs for key priorities and initiatives. Articulate strategic visions and translate them into actionable initiatives, offering alternative pathways and solutions when needed. Provide strategic support on projects and deliverables of varying complexity and across stakeholder groups, incorporating feedback and pivoting direction or proposals as needed. Manage competing departmental priorities and coordinate data requests to ensure effective and timely execution. Recommend and implement policies and operational changes that support cost savings, process improvements, and future expansion efforts. Communicate data findings, insights, and strategic recommendations to department leadership, stakeholders, and executive teams. Stay current on and interpret state and federal legislation impacting Medicaid dollars and operations. Conduct local and national market research to identify opportunities for operational innovation. Ensure regulatory compliance while enhancing infrastructure and minimizing operational risk. Support third-party administrator (TPA) business accounts. Travel frequently to Eastern Oregon and other regions across the state. Perform other duties as assigned. Required Skills & Experience: Bachelor's degree in Business Administration, Finance, or a related field, required; Master's degree preferred. Minimum of 4 years of experience in Oregon Medicaid, healthcare operations, or regulatory compliance, with strong knowledge of financial principles and cost management. Proven ability to identify cost savings and implement operational improvements within healthcare systems. Experience with claims pricing, contract configuration, negotiation, and management, including the ability to identify and propose alternative strategies during complex negotiations. Strong project management, organizational, and analytical skills. Proficiency in Microsoft Office, with the ability to create effective reports and dashboards. Skilled in presenting data, proposals, and recommendations to executive leadership and diverse stakeholders. Excellent written, verbal, and interpersonal communication skills for effective cross-functional collaboration. Demonstrated situational awareness, emotional intelligence, and confident leadership in navigating complex or sensitive situations. Track record of innovation, adaptability, and collaboration in dynamic environments. High attention to detail, reliability, and consistent follow-through. Professional appearance and demeanor in all internal and external interactions. Must possess a valid driver's license. Contact with Others & 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. Frequent travel. Internally with Medicaid Leadership, including the Board of Directors, Clinical Advisory Panel, and internal departments. Externally with various entities and stakeholders. 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 ***************************** email.
    $70.6k-88.2k yearly Easy Apply 60d+ ago
  • Senior Coding Quality Educator - Onsite

    Providence Health & Services 4.2company rating

    Remote or Tye, TX job

    Senior Coding Quality Educator _Remote - Most states eligible._ _Providence caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them._ Providence is calling a Senior Coding Quality Educator who will: + Assist with the day-to-day operations of the Coding Integrity, Knowledge Management team + Assist with research and developing coding guidance based on local, state and federal healthcare coding regulations and other payor guidelines as applicable + Obtain, interpret, analyze and communicate information regarding coding matters with all internal and external revenue cycle and coding teams + Collaborate with various departments e.g., Physician Network Operations, Revenue Cycle, Compliance, Practice Operations, and other key stakeholders on all coding matters We welcome 100% remote work for residents in the United States with the exception of the following States: + Colorado + Hawaii + Massachusetts + New York + Ohio + Pennsylvania Essential Functions: + Assist with the identification, development and delivery of new and ongoing coding changes and updates to all regional coding teams + Collaborate with various departments e.g., regional coding teams, revenue cycle, compliance, practice operations, and other key stakeholders on all coding matters + Respond timely (either orally or written) to coding inquiries from coders, educators, and other teams across Providence enterprise + Serve as a resource and subject matter expert for all coding matters + Provide coding support to regional coding teams as needed + Maintain relevant documentation and data as required + Review and update coding guidance annually or as necessary + Maintain document control + Develops action plans as necessary to resolve complex coding cases and to address the implementation of new service offerings or code changes + Facilitates education to support Medicare Risk requirements & organization goals + Review relevant patient details from the medical record based on coding and documentation guidelines + Participate in monthly progress meetings to discuss process improvements, updates in technology, along with any job related details + Communicate any coding updates published in third-party payer newsletters and bulletins and provider manuals to coding and reimbursement staff + Assists management in identifying and creating standardized workflows + Reviews EMR templates and identifies areas of improvement for provider documentation + Attends and presents at regional meetings as needed Required qualifications for this position include: + High School Diploma or GED Equivalency + National Certification from American Health Information Management Association upon hire or National Certification from American Health Information Management Association upon hire. + 6+ years of experience in professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work + 5+ years of experience providing provider education and feedback to facilitate improvement in documentation and coding + Strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment Preferred qualifications for this position include: + Associate Degree in Health Information Technology or another related field of study + Bachelor's Degree in Health Information Technology or another related field of study + 5+ years of experience in coding for multispecialty practice + 2+ years of experience in professional fee billing methodologies + Experience with IDX, Allscripts, Advanced Web, Meditech + Experience with project management Salary Range by Location: AK: Anchorage: Min: $40.11, Max: $62.27 AK: Kodiak, Seward, Valdez: Min: $41.81, Max: $64.91 California: Humboldt: Min: $40.98, Max: $64.88 California: All Northern California - Except Humboldt: Min:$46.91, Max: $72.82 California: All Southern California - Except Bakersfield: Min: $41.81, Max: $64.91 California: Bakersfield: Min: $40.11, Max: $62.27 Idaho: Min: $35.69, Max: $55.41 Montana: Except Great Falls: Min: $32.29, Max: $50.13 Montana: Great Falls: Min: $30.59, Max: $47.49 New Mexico: Min: $32.29, Max: $50.13 Nevada: Min: $41.81, Max: $64.91 Oregon: Non-Portland Service Area: Min: $37.39, Max: $58.05 Oregon: Portland Service Area: Min: $40.11, Max: $62.27 Texas: Min: $30.59, Max: $47.49 Washington: Western - Except Tukwila: Min: $41.81, Max: $64.91 Washington: Southwest - Olympia, Centralia & Below: Min: $40.11, Max: $62.27 Washington: Tukwila: Min: $41.81, Max: $64.91 Washington: Eastern: Min: $35.69, Max: $55.41 Washington: South Eastern: Min: $37.39, Max: $58.05 Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 411100 Company: Providence Jobs Job Category: Coding Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 4010 SS PE OPTIM Address: TX Lubbock 3615 19th St Work Location: Covenant Medical Center Workplace Type: On-site Pay Range: $See posting - $See posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
    $40.1 hourly Auto-Apply 4d ago
  • Senior Corporate Counsel - M&A, Transactions, Strategic Contracts

    Providence Health & Services 4.2company rating

    Portland, OR job

    The Role This person will be based in Seattle or Renton, WA, Portland, OR, or Irvine, CA The Senior Corporate Counsel position is responsible, under the guidance of Department of Legal Affairs (DLA) Leadership, for providing valued, strategic, and practical legal advice and support for Providence St. Joseph Health ("Providence") in a wide range of complex mergers and acquisitions, and healthcare transactions, including joint ventures, affiliations, partnerships, divestitures, and other healthcare-related business arrangements. The candidate will provide expert, strategic, and solutions-focused legal counsel on a broad range of complex transactions across Providence's multi-state system. This senior attorney partners closely with executive leadership, corporate development, finance, operations, compliance, and other stakeholders to structure, evaluate, negotiate and execute transactions that support Providence's business objectives and Mission. The role requires substantial experience managing complex transactions end-to-end, a high degree of independent judgement, and the ability to lead cross-functional teams through time critical matters. Key Position Responsibilities + Serve as lead transactions counsel on a wide variety of complex healthcare transactions, including mergers, acquisitions, divestitures, joint ventures, strategic affiliations, dispositions, and internal reorganizations. + Draft, negotiate and manage end-to-end transaction documents, including purchase agreements, joint venture agreements, operating agreements, governing documents (e.g., articles, bylaws, etc.) and ancillary transaction documents in compliance with applicable statutes, regulations, and policies, and in accordance with relevant legal relationships. + Structure transactions in alignment with Providence's priorities, while anticipating and mitigating legal, regulatory, and business risks. + Advise senior executives and internal business partners on transaction strategy, risk management, deal structure, diligence findings, and negotiation positions. + Work closely with internal stakeholders, including finance, operations, and compliance, to structure and execute transactions that align with business objectives. + Oversee and coordinate legal due diligence across multiple workstreams in connection with corporate transactions. + Identify, assess and clearly communicate material risks, regulatory constraints, and deal-critical issues. + Ensure transactions comply with federal and state healthcare regulatory requirements, nonprofit legal obligations, and internal policies. + Collaborate within DLA to streamline the delivery of legal services; provide consistent, effective legal advice; and manage legal resources. + Manage outside counsel efficiently and strategically on major transactions to ensure cost efficiencies, and positional consistency and support. + Function independently with respect to highly complex contracts and transactions. + Assumes responsibility for administrative functions within DLA, as assigned. Qualifications + Juris Doctor degree from an accredited law school. + Active admission and license to practice law in either California or Washington or willingness to obtain license in either of those states). + At least 10 years of relevant experience (some law firm experience is a plus) with a focus on transaction, commercial contracting, and healthcare-related matters preferred. + Strong proficiency in drafting and negotiating agreements related to mergers and acquisitions, corporate finance transactions, joint ventures, strategic alliances, and internal reorganizations. + Experience with entity formation, corporate finance, health care organizations, for-profit as well as non-profit transactions preferred. + Strong drafting, negotiation and analytic skills. + Ability to recognize and weigh business and legal risks, think strategically and advance practical solutions. + Ability to provide sound and practical advice on legal and business matters in a complex, fast-paced environment to a broad range of business teams. + Superior drafting skills, especially the ability to draft contract language that is clear, concise, and easily understood, creating templates and processes to improve efficiency of the contract review process. + Superior communication skills in both written and verbal presentation, including all aspects of legal writing technique and procedure, and the ability to convey complex legal concepts to non-lawyers. + Ability to function effectively and complete projects in a timely manner in a fast-paced environment. + Ability to work collaboratively with attorneys and staff within DLA and Providence. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Requsition ID: 393485 Company: Providence Jobs Job Category: Legal Job Function: Legal/Compliance/Risk Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 4015 SS LEGAL Address: WA Seattle 800 Fifth Ave Work Location: Swedish Bank Of America Bldg-Seattle Workplace Type: Hybrid Pay Range: $280K - $350K The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
    $103k-174k yearly est. Auto-Apply 36d ago
  • Manager, Web Application Development

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 The Software Engineering Manager will supervise a team of skilled developers responsible for building, integrating, and supporting critical web-based systems serving both internal and external customers and business partners. Applications include online portals, sales and marketing tools, intranet collaboration, and customer support services. Directly reporting to this role are software engineering managers for each of the development teams. The development team includes software engineers focused on developing solutions using Java, .Net, JavaScript, Web Services, and Content Management Systems. You will collaborate with business teams and IT stakeholders to determine and implement online solutions which support Moda Health's goals. This is a FT WFH position. Pay Range $113,543.26 - $147,602.10 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. ************************** GK=27766416&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 Computer Science or a related field. Minimum of five (5) years of experience programming or managing the development of web applications using Java or .Net technologies. Extensive understanding of web technologies, software engineering, and programming languages. Ability to keep current with emerging internet technologies. Solid background in client/server programming and relational database systems. Outstanding analytical, problem-solving, organizational, and detail orientation skills. Strong ability to negotiate, prioritize, determine tasks, and allocate resources. Ability to work well under pressure, work with frequent interruptions, and shifting priorities. Maintain confidentiality and project a professional business image. Demonstrated ability to manage customer escalations. Willingness to work additional or non-standard hours when necessary. Primary Functions: Oversees and coordinates activities for a single web development team, including but not limited to, hiring, monitoring performance, training, coaching, and mentoring. Makes recommendations for processes and policies used to develop systems and services. Effectively communicate project status, project goals, and milestones to customers as needed. Provides guidance, estimates, and recommendations on system development, Supervises the creation, update, and maintenance of system support documentation. Effectively collaborate with internal and external stakeholders to identify and prioritize project deliverables. Ability to project a professional business image and maintain confidentiality. Perform other duties and responsibilities 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. 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 ***************************** email.
    $113.5k-147.6k yearly Easy Apply 13d ago
  • Manager, Pharmacy Business Development

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 We are seeking a Manager of Pharmacy Business Development with a focus on industry relations. The domain expertise to be successful in this role requires foundational clinical pharmacy experience, accompanied by a high degree of business acumen, and an interest and passion for partnering closely with pharmaceutical and biotechnology companies, and other vendor partners who engage in contracting opportunities such as rebate management, and clinical programs. Overall, this position is responsible for development of strategic formulary approaches for the management of medications across the medical and pharmacy benefits, driving to low net cost medication utilization. This position includes reviewing rebate initiatives for medications covered under the pharmacy and medical benefits, across various lines of business including commercial, Exchange, Medicare and Managed Medicaid. The role includes facilitating or supporting the implementation of projects or activities with both external and internal stakeholders and articulating this value as necessary. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered. Pay Range $134,104.74 - $170,987.17 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. ************************** GK=27766011&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree. Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of employment. Past supervisory experience managing a team. Three to five years of managed care experience, time can be inclusive of training from an accredited managed care residency program. Experience with Commercial, Medicare, and/or Medicaid lines of business. Experience managing contracts, particularly with biopharmaceutical manufacturers and other pharmacy vendors. Technical understanding of pharmacy claims processing information and systems. Strong analytical skills and business acumen. Ability to communicate and present technical information appropriate for the audience. Ability to work independently and collaborate cross-functionally with various stakeholders. Project management skills and the ability to plan and execute projects as assigned. Commitment to service, organization values, and professionalism. Ability to maintain confidentiality and project a professional business image. Works well under pressure with frequent interruptions and shifting priorities. Ability to work independently. Proficient with Microsoft Office applications such as Word, Excel, Outlook, and PowerPoint. Primary Functions: Lead industry relations and rebate strategies for medical and pharmacy benefit medications, and new and emerging therapies, across all lines of business. Oversee all rebate partners and lead evaluations of new potential partners. Identify and negotiate direct contracts with biopharmaceutical partners. Identify, manage, and assess the value of unique vendor partnerships to advance pharmacy programs, including drug information resources, medical management organizations, digital therapeutics, and point of service solutions. Responsible for ensuring compliance with rebate contracts, rebate terms within client contracts, and contracts held with other vendor partners. Lead rebate modeling and optimize rebate scenarios and bid selections based on client specific goals and strategies. Oversee pipeline developments, including market events and material changes to therapeutic categories, for new and emerging therapies, specialty, and traditional medications, and keeps internal and external stakeholders apprised of such events. Develops educational materials as needed. Leads custom formulary rebate offerings and recommendations for downstream clients. In collaboration with other pharmacy leaders, develop enterprise-wide industry relations strategy. Oversee, develop and manage Moda's Industry Relations team. Lead rebate offerings for existing therapeutic strategies which support ongoing formulary performance, but also identify new opportunities either as contracting changes or new market entrants are FDA-approved. Work closely with vendor partners (PBM, medical management companies, others) on policy or formulary changes driven by cost analysis, including rebate considerations or contracting. Support and/or lead client facing presentations within industry relations as necessary. Responsible for information gathering with legal and/or regulatory teams to understand impact to current formulary strategies, with financial implications, to anticipate or plan for any potential compliance driven update due to changes in existing, or new and emerging states of business. Monitor, anticipate changes, and prepare for pipeline and market events. Develop concise, applicable, comprehensive, and timely communiques as assigned for members, providers, internal, or external stakeholders. Provide clinical support services that intersect industry relations or business development, including but not limited to benefit design, formulary analysis, drug information, P&T participation, client support, and drug utilization management. Contribute, update, and maintain policies and procedures related to industry relations. Complete significant projects and performs all other related duties as assigned. Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information. Working Conditions & Contact with Others Remote, office environment, and/or hybrid with extensive close PC and keyboard work, and constant sitting. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business needs. May require occasional travel to conferences or offsite business meetings. Internally with Clinical Pharmacy, Analytics, Marketing, Sales & Account Services, Actuary & Underwriting, Healthcare Services, Medicare and Medicaid Programs, Benefits, Legal, Regulatory Affairs, and Compliance. Externally with PBM, medical management vendor, pharmaceutical and biotechnology manufacturers, consultants and benefit managers, clients, providers, and pharmacists. 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 ***************************** email.
    $134.1k-171k yearly Easy Apply 60d+ ago
  • Provider Correspondence Coordinator I

    Moda Health 4.5company rating

    Moda Health job in Milwaukie, OR

    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 Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department. This position researches and provides written response to medical provider correspondence and appeals regarding claim edits, processing, authorizations and medical necessity reviews; researches and provides written response to medical inquiries regarding benefit and plan design issues. This is a FT WFH role. Pay Range $19.05 - $21.43 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. ************************** GK=27769231&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: High School education or equivalency. 6 months - 2 years' medical claims processing or customer service experience. Strong reading, writing and verbal communication skills Good analytical, problem solving, decision making and organizational skills. 10 key proficiency of 105 spm net on a computer numeric keypad. Type a minimum of 35 wpm net on a computer keyboard. Ability to work under pressure and meet mandated time frames. Ability to read and interpret contracts and apply Moda Health policies and procedures. Ability to communicate positively, patiently, and courteously with callers. Proficiency in Facets, Content Manager and EBT. Proficiency in computer applications such as Word and Excel. Ability to maintain confidentiality and project a professional business image. Primary Functions: Responds to provider appeals and related correspondence. Interacts with physician/provider offices by letter or phone to gather additional information regarding claim disputes. Performs a total claim review to determine over/underpayment on problem claims. Works with Claims Support to adjust previously processed claims. Documents accurately in Facets regarding outcome of claims disputes. Meets the departments established standards for case completion. Other duties as assigned. Working Conditions & Contact with Others: 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, Customer Service, Healthcare Services, Membership Accounting, Information Technology, and Professional Relations. Externally with Providers, Members, Vendors, and Insurance companies. 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 ***************************** email.
    $19.1-21.4 hourly Easy Apply 13d ago
  • Dermatologist

    Providence Health & Services 4.2company rating

    Happy Valley, OR job

    We are recruiting for a full-time BC/BE dermatologist at Providence Medical Group (PMG) Dermatology in the Portland, OR Metro area. PMG Dermatology is a well-established group of 20 dermatologists and one Mohs surgeon. We have 5 clinics throughout the Portland Metro area. We have an open position at our PMG Clackamas Dermatology, (delete comma) location about 10 miles from downtown Portland in NE Portland and would love for you to join us! Our physicians, department leadership and clinic operations teams work closely together to foster a culture of excellence. We are committed to high quality patient care and a sustainable and joyful work environment. We consistently earn top scores in patient satisfaction as well as physician and staff engagement. We enjoy outstanding quality of life in the beautiful Pacific Northwest, with mountain snow, ocean beaches and the Willamette Valley wine country close by. * We have an open positions for either 0.75 FTE (3 days per week) or 1.0 FTE (4 days per week), with 8.5 hours per day of patient care. * We schedule 15-minute appointments for regular office visits and 30-60 -45 min for procedure appointments based on physician preference. * You will have flexibility in designing your schedule template. * Option to do cosmetic treatments. * Option to read some or all of your own dermatopathology. * Narrowband UVB phototherapy and photodynamic therapy available on site. * New graduates are welcome to apply. * Guaranteed salary base of $400,000 for 1.0 FTE (pro-rated for 0.75 FTE). * Production bonus with bi-weekly compensation calculated based on a rolling 4-month average of wRVU production. You could expect to increase your base salary by 75+% after 4 months of a full schedule. We have hundreds of patients on our wait list, and you can be as busy as you'd like as soon as you'd like. * CME allowance of $6000 and 80 hours per year for 1.0 FTE. * Starting bonus and relocation assistance offered. * Comprehensive benefit package including Paid Time Off (26.4 days per year for 1.0 FTE), Health, Dental, Vision, Life, Disability, and Malpractice Insurance. * As a non-profit organization, Providence is an eligible employer for the Public Service Loan Forgiveness (PSLF) program. Where You'll Work Providence Medical Group is an organization of employed physicians, with more than 90 clinics across the state of Oregon. Its 1,500+ providers possess a wide range of clinical expertise, including Family and Internal Medicine, Infectious Disease, Dermatology and Occupational Medicine. At Providence Medical Group, patients enjoy close-to-home access to dedicated providers in primary, specialty or urgent care clinics, with clinical and operational support from centralized Providence programs. Where You'll Live Nestled in the sceneic Willamette Valley, Clackamas, Oregon, offers the prefect blend of suburban comfort, outdoor adventure and city amenities. Located less than 20 minutes from downtown Potland and easily accessible via MAX Light Rail, Clackamas boasts top-rated schools, a thriving local economy and a strong sense of community. It's an ideal place to put down roots for families and professionals alike. Who You'll Work For Providence is a nationally recognized, comprehensive healthcare organization spanning seven states with a universal mission - to provide compassionate care to all who need its services, especially the poor and vulnerable. Its 122,000-plus caregivers/employees (including 34,000 physicians) serve in 51 hospitals, more than 1,000 clinics and a comprehensive range of health and social services. Providence: One name, one family, one extraordinary health system. Check out our benefits page for more information. Equal Opportunity Employer including disability/veteran _Job ID Number: 29826_ _Facility Name: Providence Medical Group - Oregon_ _Location Name: Clackamas (Portland Metro Area)_ _Brand Name: Providence_ _Provider Profession: Physician/Surgeon_ _Medical Specialty: Dermatology_ _Job Setting: Medical Clinic_ _Type of Role: Clinical_ _Email: *******************************_ _Phone Number: **************_ _Schedule: Full Time_ _CP: Yes_ _CB: Yes_ _NP:_ _PA:_ _HC: Yes_ _IS: No_ _YM: Yes_ _J1: No_ _H1B: No_ Let's get in touch If you have questions about this specific job or others, I'm all ears. Send me a note and we'll be one step closer to the right opportunity. Heather Mitchell Provider Recruiter ************** ******************************* Contact Me
    $400k yearly Auto-Apply 60d+ ago
  • Health Promotion & Wellness Consultant

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 Health Promotion and Wellness Consultant will partner with Moda Health's employer groups to consult on high-impact workplace wellness program. The Consultant will identify key strategies to build wellness into company cultures and to maximize employee engagement in workplace wellness programs. Some human capital initiatives include health assessments, health education presentations, interest surveys, needs assessments, and connections to Moda Health and vendor resources - all of which support our clients' organizational health and wellness efforts. This is a FT hybrid position based in Portland, Oregon. Pay Range $48,900.76 - $61,125.95 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. ************************** GK=27768547&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 and two years of experience in wellness, public health, health promotion, health coaching or healthcare preferred. Strong customer service, written & verbal communication skills. Ability to work independently and collaboratively with a team. Thorough knowledge and understanding of health behavior change theory and workplace environmental applications. Strong organizational, time-management, and problem-solving skills, with high attention to detail. Proficiency in Microsoft Word, Excel, Outlook, and Access (data entry forms). Ability to learn proprietary databases. Valid Oregon driver's license. Ability to handle a pushcart/hand truck and to lift boxes up to 40 lbs. in and out of a car trunk. Ability to maintain confidentiality and project a professional business image telephonically and in person. Primary Functions: Serves as the wellness program expert, working with groups to design, implement and evaluate worksite wellness programming, based on Moda's suite of population health and wellness programs. Serves as a liaison between the groups contact and the wellness product, providing ongoing follow up, responding to questions regarding program operations and resolving any issues. Provides basic interpretation of aggregate health risk assessment data, review of utilization reports, discussion of resources. Conducts wellness and health promotion presentations to members and employees, as needed. Works closely with group contacts to coordinate employer-based wellness activities (e.g. biometric screenings, health fairs, and activity incentives) and evaluate program impact. Contributes to the selection, development, implementation, and evaluation of educational materials and other member communications. Reviews and maintains a suite of materials; works with supervisor to identify and request additional resources, as needed. Develops and maintains effective and productive relationships with clients, prospects, vendors, and other Moda Health departments. Perform other duties as assigned. Working Conditions & Contact with Others: 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 multiple departments. Externally with clients and vendors. 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 ***************************** email.
    $48.9k-61.1k yearly Easy Apply 29d ago
  • Medical Claims Auditor I

    Moda Health 4.5company rating

    Moda Health job in Milwaukie, OR

    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 Provides accurate quality assurance auditing of post-payment claims to determine correct adjudication and benefit application. Completes complex reports and provide feedback on accuracy. This is a FT WFH position. 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. ************************** GK=27758424&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Requirements: High school diploma or equivalent. 6 months - 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels. Strong reading, writing, and verbal communication skills. Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities. 10-key proficiency on a computer numeric keypad. Type a minimum of 25 wpm net on a numeric keyboard. Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines. Ability to maintain confidentiality and project a professional business image. Ability to come into work on time and daily. Proficiency in Facets claims processing applications and Benefit Tracker. Knowledge of Business Objects and Employer Online Services is helpful. Knowledge and understanding of Delta Dental's administrative policies affecting claims and customer service. Computer proficiency in Microsoft office applications. Primary Functions: Audit claims daily using a statistically valid sampling method, and prescriber audit criteria. Performs simple adjustments as necessary. Conduct in-depth claims audits on performance groups, as well as focus audits for specifically identified situations on a scheduled basis. Compiles and publishes reports based on the results of claim audits as well as processor productivity on a weekly, monthly, and quarterly basis. Run report in Business Objects to conduct audits. Prepares required monthly and/or quarterly reports for specific group performance guarantee, production, and accuracy results. Identify trends from audit results and recommend improvements to increase overall quality. Assists in the investigation and response to Market Conduct Examination inquiries. Other duties as assigned Contact with Others Internally with Claims, Sales & Account Services, Membership Accounting, Benefit Configuration, Information Services, Customer Service and Provider Relations. 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 standard work 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 & Danielle Baker via our ***************************** email.
    $18-20.2 hourly Easy Apply 16d ago
  • PT - Physical Therapy

    Providence Health & Services Ne Halsey 4.2company rating

    Portland, OR job

    MedSource Travelers offers assignments nationwide and is currently seeking a qualified PT Physical Therapy with 1-2 year's experience for a travel assignment in Portland, Oregon. Please have resume, skills checklist and 2-3 references within the last 12 months. Contact us today about job details. The benefits of MedSource Travelers include, Weekly Pay Holiday Pay Continuing Education Referral Bonus Medical Benefits Dental Benefits Vision Benefits Let's get started!
    $27k-30k yearly est. 15d ago
  • Information Security Operations Analyst

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 The Operations Analyst is a technical role within Moda's Information Security team and will play a vital role in keeping the organization's proprietary and sensitive information secure. This position works interdepartmentally to investigate issues, identify and correct flaws in security systems, solutions, and programs, and recommend measures to improve the company's overall security posture. Acting as a liaison between Security and IT management, the analyst assists IT strategy and architecture design from a security perspective and identifies issues, concerns, or recommendations as the organization grows its technology infrastructure and processes. This is a FT WFH position. Pay Range $70,496.52 - $91,647.55 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. ************************** GK=27768922&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 or master's in Computer Science, Information Security, Cybersecurity, or a related field. 5+ years of experience as a security operations analyst or in related fields such as IT audit, enterprise risk management, penetration testing, or red team/incident response. Experience with common security tools such as SIEM platforms, EDR solutions, and cloud platforms (e.g., Microsoft Azure, Amazon AWS). Knowledge of Microsoft Azure configuration and management is highly desirable. 3+ years of experience with regulatory compliance and information security management frameworks (e.g., HIPAA, NIST, IS0 27000, or COBIT). Strong documentation and reporting skills, including the ability to record security events, investigations, and recommendations for technical and non-technical audiences. Excellent collaboration and communication skills with the ability to influence and work effectively across cross-functional teams. Industry recognized cybersecurity certification (e.g., CISSP, CISM, CompTIA Security+) preferred. Primary Functions: Defend against cybersecurity incidents and identify, analyze, communicate, and contain incidents as they occur. Monitor systems and networks for security alerts, notifications, and issues including patching and update process issues and investigate and document any security issues or events that may occur. Own and drive the investigation of security events and other cybersecurity incidents including review, triage, and response to alerts and notifications. Take a lead role in the documentation of security events and incidents and the assessment of the damage they cause. Review threat intelligence and analyze the current threat landscape and apply threat analysis to Moda's infrastructure systems and networks to identify and address vulnerabilities or exploitable attack paths. Build and drive proactive threat hunting programs including detailed threat analysis of exploitable vulnerabilities leading to actionable remediation plans. Work with IT resources and architects to develop and implement cloud security strategies to facilitate migration of key assets into a public cloud hosted environment. Advise on installation and configuration of security controls, systems, and software to protect systems and information infrastructure and recommend enhancements based on compliance requirements and industry best practices. Work with IT and Security leadership to perform tests or support external testing such as network penetration tests, vulnerability testing, and disaster response failover tests to uncover network vulnerabilities. Advise on installation and configuration of security controls, systems, and software to protect systems and information infrastructure and recommend enhancements based on compliance requirements and industry best practices. Take a proactive and operational role in creating the best practices for IT security companywide. Support cybersecurity risk assessment activities. Work with both Security and IT management to ensure security policies and goals are met in infrastructure and development contexts. Stay current on IT security trends and news including evolving standards. Collaborate and communicate effectively with cross functional colleagues at all levels. Other duties as assigned. Working Conditions: Remote 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 all departments. Externally with auditors, clients, technology partners, and other various entities. 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 ***************************** email.
    $70.5k-91.6k yearly Easy Apply 16d ago
  • Medical Claims Processor I

    Moda Health 4.5company rating

    Moda Health job in Milwaukie, OR

    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 Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company. This is a FT WFH role. Pay Range $17.00 - $19.03 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. ************************** GK=27768550&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: High School diploma or equivalent 6-12 months data entry or medical office experience preferred 10-key proficiency of 135 spm Type a minimum of 35 wpm Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred Demonstrates work habits that include punctuality, organization, and flexibility Ability to maintain balanced performance in areas of production and quality Analytical reasoning and flexibility Professional and effective written and verbal communication skills Experience with Facets platform a plus Identify all the duties and responsibilities Primary Functions: Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures. Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims. Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc. Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system. Adjudication of claims to achieve quality and production standards applicable to this position. Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards. Reviews Policies and Procedures (P&P'S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements. Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda's standard workweek is a 37.5 hour work week. Working Conditions & Contact with Others: Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda's standard workweek is a 37.5 hour work week. Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs. 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 ***************************** email.
    $17-19 hourly Easy Apply 29d ago
  • Supervisor Data Engineering

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 The Data Engineering Supervisor leads a team of 5-7 engineers and architects while contributing directly to technical development. This role oversees enterprise data solutions, including data warehousing, ETL/ELT pipelines, and analytics engineering processes. The supervisor drives the implementation of scalable data transformation frameworks to support business intelligence and advanced analytics. They ensure data quality, governance, and performance optimization while guiding the team in building robust, automated solutions that enable data-driven decision-making across the organization. This is a FT WFH position. Pay Range $109,420.90 - $150,000.00 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. ************************** GK=27769232&refresh=true Benefits: Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: Proven leadership experience managing people and data-focused technical teams, with the ability to guide diverse, interdisciplinary teams with varying skill sets and experience levels. 7+ years of experience in data or analytics engineering with ETL/ELT pipeline design, development, and maintenance. Healthcare data experience is preferred. 10+ years of SQL experience across on-prem servers (SQL Server) and cloud data warehouses (Snowflake, MS Fabric, BigQuery, Redshift). Experience migrating on-prem databases to cloud data warehouses strongly preferred. Expertise in data architecture principles, dimensional modeling, and enterprise data integration strategies. Experience with data pipeline orchestration tools such as SSIS, SQL Agent, Tidal, Airflow, and dbt. Ability to collaboratively develop and implement analytics and reporting solutions. Experience supporting Power BI or other modern BI tools preferred. Strong understanding of data modeling principles, documentation, and tools. Ability to communicate complex analytical solutions to audiences with varying technical understanding. Strong organizational skills to plan, prioritize, and meet departmental goals and timelines. Ability to work effectively under pressure in a complex, rapidly changing environment. Ability to work independently with minimal supervision. Primary Functions: Oversee and coordinate data engineering and analytics engineering activities, including the design, development, implementation, and ongoing improvement and management of the Enterprise Data Warehouse (EDW). Set clear objectives, monitor progress, and conduct regular performance reviews for the data engineering team. Gather and translate business requirements into technical solutions by designing data models, building transformation workflows, and applying best practices for data architecture and governance. Develop data models and pipelines while supervising the overall management of the EDW using diverse tools. Collaborate with analytics and business teams, providing technical guidance, peer reviews, and support for ad hoc data queries and reporting needs. Lead hiring, onboarding, training, coaching, and performance management to build a high-performing team. Ensure compliance with data governance, security, and quality standards. Continuously optimize processes to support data-driven decision-making. 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 customers of the Data Science team. Externally with Data Science customers, and vendors of technology and business solutions. 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 ***************************** email.
    $109.4k-150k yearly Easy Apply 13d ago
  • Prior Auth Coordinator I - Temporary

    Moda Health 4.5company rating

    Moda Health job in Portland, OR

    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 will provide support to the Medical Management team by assisting in the investigation and research of prior authorization requests. Completes reviews or support the clinical staff in the review processes by preparing or completing the requests as assigned. This is a Temporary WFH role. Pay Range $18.03 - $20.18 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. ************************** GK=27759276&refresh=true Benefits: Medical, Dental, Vision & Pharmacy PTO and Company Paid Holidays 401k - Matching Required Skills, Experience & Education: High school education or equivalent. 1-2 years of experience in a medical office and/or insurance experience needed. Strong problem-solving skills and decision quality preferred. High level of understanding of medical terminology and coding, state and federal regulations for claims adjudication and provider contracting. Knowledge of Health Plan benefits. Type a minimum of 35 wpm and 10key proficiency of 135spm on computer number keypad. Proficient with PC and Microsoft Office applications. Excellent written, verbal, and interpersonal communication skills including demonstrated business writing and grammar skills. Ability to interpret complex benefit packages and contract language. Excellent organizational and detail orientation skills. Ability to work independently, as well as part of a team, dealing with all levels of staff, members, providers, in a professional manner. Ability to maintain confidentiality. Ability to come to work on time and daily. Ability to work well under pressure, work with frequent interruptions and shifting priorities. Must present a professional business image in all settings. Primary Functions: Review and research referral and authorization requests received in Healthcare Services. Process or route per appropriate guideline. Determines the requirement for prior authorization based on the plan type, ICD-10 code, CPT/HCPC code or place of service. Provides education to members and providers regarding prior authorization process. Interacts with providers and provider offices to gather complete, accurate information to process prior authorizations and referrals and coordinates with providers to ensure consideration is given to unique treatment. Consults the RN, Manager or Supervisor on complex cases. Responsible for daily administrative functions of the clinical team in Healthcare Services, ensuring deadlines are met to support required processes of the clinical team, members and providers as well as facilitates the timely processing of documentation submitted to the Medical Management department. Utilizes the Moda Health systems for documentation of contact with providers and members. Communicates effectively with other Medical Management support staff. Analyze claims and encounters according to the limits of authorization, benefit plan and provider contracts. Effectively uses the Moda Health systems to accurately determine eligibility, benefit plan, and physician networks associated with the member's plan. Completes approvals, and denials by the medical director, of claims and prior authorization requests in a professional, positive manner. Send proper correspondence to providers, members, and other departments to either obtain additional information necessary for the review of claims or denial of requested services. Analyze authorizations for correct information, such as authorization maximums, limitations, and special instructions for performance groups. Ensure adherence of Health Insurance Portability and Accountability Act (HIPAA) and other regulatory guidelines including privacy and security. Responsible for the auditing of individual daily work for accuracy, consistency and compliance based on Moda Health policies and procedures, state, federal and CMS (Medicare)/Medicaid regulations. Identifies problems and researches alternative solutions. Works with other team members to maintain the workflow to meet productivity and compliance standards. Completes other duties and special projects as assigned by the HCS Supervisor and/or the HCS Manager. Maintains an established productivity based on the complexity and demands of a heavy workload, complex services agreements, provider contracts and complex benefit packages. Responsible for utilizing all applicable policies, procedures and materials used in determining the proper review of claims, review, and processing of prior authorization requests for services. Enter data into appropriate system Facets UM or CT Dynamo must be able to accurately determine member eligibility and provider participation within a network. Maintain accurate patient note entry when not approving a request, when awaiting additional information or when routing the referral or preauthorization request. Perform other duties as assigned. Working Conditions & Contact with Others 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. Internally with own department and Customer Service. Externally with Moda members, PBM vendor, providers, provider offices. 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 ***************************** email.
    $18-20.2 hourly Easy Apply 11d ago
  • Clinical Liaison RN

    Providence Health and Services 4.2company rating

    Phoenix, OR job

    The Clinical Liaison RN at Providence Medford Medical Center coordinates home care services between Providence Home Services and contracted facilities, facilitating patient transitions post-hospitalization. This role acts as a clinical resource, educating hospital staff and contributing to discharge planning. Candidates require an Oregon RN license, clinical experience, and strong communication skills, with preferred experience in liaison, marketing, or Epic EMR systems. Description This role is located at Providence Medford Medical Center. This position represents Providence Home Services (HS) at contracted facilities and requires strong communication and interpersonal skills. The role of the Clinical Liaison RN is to coordinate and arrange home care services between HS and contracted facilities for home health, home infusion, hospice, and home medical equipment associated with a clinical referral, except when there is an onsite HME liaison. The position acts as a clinical resource and educates hospital staff regarding the services offered by HS, and contributes to the patient care plan as it relates to the discharge plan. The Clinical Liaison provides information to ensure a smooth transition for patients and their families following hospitalization. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Home Services Oregon and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: Upon hire: Oregon Registered Nurse License. Upon hire: National Provider BLS - American Heart Association. 1 year Full-time experience in clinical role. Preferred qualifications: Liaison, marketing or sales experience. Health care industry experience. Documented successful sales account medical management experience. Epic EMR experience. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.' Requsition ID: Company: Providence Jobs Job Category: Nursing-Patient Facing Job Function: Nursing Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 5015 BUSINESS DEVELOPMENT OR REGION Address: OR Medford 1111 Crater Lake Ave Work Location: Providence Medford Medical Center Workplace Type: On-site Pay Range: $43.38 - $67.36 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. PandoLogic. Category:Healthcare, Keywords:Nursing Service Administrator, Location:Phoenix, OR-97535 Keywords: Clinical Liaison RN, Registered Nurse, Home Health Care, Patient Care Coordination, Discharge Planning, Hospice Care, Home Infusion Services, Medical Equipment Liaison, Epic EMR, Healthcare Communication
    $16k-73k yearly est. 1d ago
  • Contracts Specialist, Community Connect, Virtual

    Providence Health & Services 4.2company rating

    Moro, OR job

    Providence caregivers are not simply valued - they're invaluable. Join our team at Enterprise Information Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. The contract specialist plays a key role in supporting the operations and business development team by coordinating the full lifecycle of contracts related to creating, editing, and maintaining change request contracts for community connect clinics and hospitals. This position ensures that all client Agreements comply with organizational policies and applicable legal standards. This role requires strong attention to detail and the ability to communicate effectively with internal stakeholders. Providence supports 100% virtual work for residents located in the following areas: + Alaska + Washington + Oregon + Montana + California + Texas: Lubbock (within 65 miles) + Texas: Levelland (within 65 miles) + Texas: Plainview (within 65 miles) Required Qualifications: + Associate's Degree or another Closely related field of study -OR- a combination of equivalent education and experience + 2 or more years of experience with payer billing, collections and reimbursement methodologies, and contract language requirements Preferred Qualifications: + Bachelor's Degree or another closely related field of study + 2 or more years of experience working with contract laws and legal terminology + Skilled in reading, analyzing, and interpreting and understanding financial data related to contracts + Responsible for maintaining the accuracy and integrity of the contract documents within contract management system and shared drives + Demonstrates strong communication skills by effectively conveying ideas, actively listening, and adapting messaging to diverse audiences, ensuring clarity and collaboration across teams + Responsible for tracking and reconciling contract renewals + Exhibits exceptional attention to detail and organizational abilities, ensuring accuracy in work, maintaining structured processes, and consistently meeting deadlines with high-quality results + Coordinating the full lifecycle of change request contracts, including creating, editing, amending, and maintaining based on existing contract templates + Builds and maintains strong relationships with stakeholders by actively engaging, understanding their needs, and fostering collaboration to drive alignment and achieve shared goals + Demonstrates strong technology proficiency, leveraging Microsoft 365 tools including Microsoft Teams, Word, Excel, Outlook, and SharePoint Nice to Have: + Healthcare knowledge and or experience + Knowledge of contract managements software and tools + Experience with Salesforce or other CRM tools + Experience using Docusign or other contract signature applications Salary Range by Location: + AK: Anchorage: Min: $33.63, Max: $52.22 + AK: Kodiak, Seward, Valdez: Min: $35.06, Max: $54.43 + California: Humboldt: Min: $35.06, Max: $54.43 + California: All Northern California - Except Humboldt: Min: $39.33, Max: $61.07 + California: All Southern California: Min: $35.06, Max:$54.43 + Montana: Except Great Falls: Min: $27.08, Max: $42.04 + Montana: Great Falls: Min: $25.65, Max: $39.83 + Oregon: Non-Portland Service Area: Min: $31.35, Max: $48.68 + Oregon: Portland Service Area: Min: $33.63, Max: $52.22 + Texas - Lubbock, Levelland, Plainview: Min: $25.65, Max: $39.83 + Washington: Western: Min: $35.06, Max: $54.43 + Washington: Southwest - Olympia, Centralia: Min: $33.63, Max: $52.22 + Washington: Clark County: $33.63, Max: $52.22 + Washington: Eastern: Min: $29.93, Max: $46.46 + Washington: Southeastern: Min: $31.35, Max: $48.68 Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 410912 Company: Providence Jobs Job Category: Legal Job Function: Legal/Compliance/Risk Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 4011 SS TEGRIA COMM CONN Address: TX Lubbock 3623 22nd Pl Work Location: Covenant Health Systems Foundation Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
    $48k-65k yearly est. Auto-Apply 4d ago

Learn more about Moda Health jobs

Jobs from similar companies

Jobs from similar companies you might want to view.

Most common locations at Moda Health

Most common jobs at Moda Health

Zippia gives an in-depth look into the details of Moda Health, including salaries, political affiliations, employee data, and more, in order to inform job seekers about Moda Health. The employee data is based on information from people who have self-reported their past or current employments at Moda Health. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by Moda Health. The data presented on this page does not represent the view of Moda Health and its employees or that of Zippia.

Moda Health may also be known as or be related to Moda Health, Moda Partners Inc, OREGON DENTAL SERVICE and Oregon Dental Service Inc.