Moda Health. Healthcare from your head to your toes.

Contract Configuration Specialist

Job Title
Contract Configuration Specialist
Open Until Filled
Portland,  OR 97204
Other Location
Job Class: 108

Let’s do great things, together
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. 

We are seeking a Contract Configuration Analyst. This position analyzes provider contracts of low to moderate complexity with a substantial variety of pricing methodologies including APC, DRG, CMS, Fee schedules etc.  Determines configuration needed to meet the business requirements and configures the system to achieve a high level of accuracy and auto adjudication.  

Primary Functions:
1.    Analyzes the Medicare and Commerical provider contracts and agreements that are from institutional and non-institutional providers.  Configures the agreements and fee schedule updates in NetworX Modeler and NetworX production. Knowledge of ICD-10, CPT,  Revenue Codes, DRG’s, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies required.  
2.    Researches and resolves critical Medicare and Commercial issues that are sent from Claims, Customer Service, Provider Relations, Credentialing and Appeals.
3.    Loads and maintains new and existing providers in Facets, which includes performing accurate and timely provider research, verification and analysis.  Resolves provider load issues within established documented processes.
4.    Handles special projects and attends meetings as determined by Management.
5.    Consult with Provider Contracting negotiators to determine appropriate interpretation and configuration of contract terms.
6.    Maintains high quality of work, which includes strong knowledge of claims processing to test the configuration of the contract and verify claims are processing correctly.
7.    Other duties as assigned..

Are you ready to be a betterist?
If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.
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.

Required Skills

1. High School diploma or equivalent. College degree is a plus.
2. Minimum 1 year experience in the health insurance industry, with knowledge of standard claims billing and medical coding practices, and the impact of provider contracts on claims pricing.
3. Minimum 1 year experience in provider configuration, preferably in Facets NetworX and NetworX Modeler.
4. Experience in interpretation and analysis of provider contracts.
5. Demonstrated knowledge of standard CMS pricing methodologies.
6. Knowledge of basic credentialing processes and familiar with Cactus or credentialing vendor.
7. Demonstrated knowledge of Moda provider networks.
8. Certified Professional Coder designation and experience is a plus.
9. PC proficiency with Microsoft office applications and Outlook.
10. Strong verbal, written and interpersonal skills.
11. Typing proficiency of 35 wpm and 10-key proficiency of 135 wpm.
12. Demonstrated research and problem solving skills.
13. Ability to work well under pressure with frequent interruptions and shifting priorities.
14. Ability to analyze data, interpret and problem solve, both system and reports.