Job Description

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.

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.

Moda Health is seeking a Membership Accounting Specialist II. This position will be responsible for timely and accurate entry and maintenance of member eligibility data, generation of member ID cards, customer billing preparation and reconciliation processes, and customer service for our larger sensitive and/or more complex group accounts; assist Membership Accounting Specialist I in problem-solving and problem resolution; provide on-going technical, soft skill, coaching and support for the unit. PRIMARY FUNCTIONS: 01. Responsible for eligibility, maintenance, and reconciliation of our larger, sensitive and/or more complex accounts, via paper enrollment and EDI enrollment processes. Larger and more complex accounts include: Individual members with complex billing issues both on and off the exchange, billing discrepancies between Medicare or Medicaid, groups that make their own billing adjustments; positive billed dental, PPO & POS groups with 100+ members; managed care groups with 50+ members; 50+ phone calls per week for internal and external clients; groups with manually selected benefits; groups with multiple plans/divisions; groups that require excel billing; groups that require monthly breakdowns. Assisting in preparing enrollment mailings, including Annual Notice of Change (ANOC) and Working Aged Surveys. 02. Ensure the accuracy and timeliness of the billing process within the department, State and Federal standards depending on Product and Line of Business. Prepare spreadsheet billings for clients not billed through the system. Identify, communicate and approve all billing discrepancies and adjustments including requests for retro-active membership terminations. Handle all requests from Accounting for reconciliation of premium received and clarify premium posting issues. Proper maintenance of our billing records and allocation of cash receipts that have direct effect on the integrity of reports for Underwriting and Accounting. 03. Responsible for monitoring and upholding enrollment rules.  Requires knowledge of the following: probationary periods, waiting periods, late enrollee rules, COBRA rules, Oregon Continuation rules, retro termination procedures, domestic partner procedures, Medicare and Medicaid guidelines.  May require denial of coverage and explanation to group administrator. 04. Respond to all internal and external customer inquiries regarding eligibility, ID cards and billing issues. Responsible for verification and selection of Primary Care Physicians.  Attend customer meetings as requested by Sales and Account Services. 05. Responsible for new group installation procedures including verification of information provided.  Responsible for generation and verification of initial billing statement and/or member dependent listing, initial ID card production and introductory welcome letter. 06. Review outstanding delinquency reports; prepare customer delinquency notification letters, and coordinate coverage termination activities with Sales and Account Services. 07. Determine qualifying events and length of coverage for all members and all lines of business.  Monitor expiration dates and other reports regarding eligibility status. 08. Responsible to log and track enrollment applications in Excel and give monthly reports to the Supervisor and the groups that shows a running balance on total enrollments received; enrollments entered into our system; voids and pending. 09. Accurately enter COB, COBRA and Pre-Existing for timely and accurate claims adjudication as well as sending out required COBRA notifications. 10. Requests and verifies the issuance and accuracy of member ID cards. 11. Keeping track of supplies and ordering when necessary. 12. Process Return Mail 13. Adhere to and enforces group contract, State and Federal guidelines regarding eligibility standards and requirements. 14. Confidently represent department and division in project and strategy meetings. 15. Enter information during enrollment that assists Claims departments in claims adjudication process, including: COB, Pre-existing coverage and COBRA data.  Assist in claim denials related to the enrollment process; requires knowledge of claims processing procedures and company computer system. 16. Be a supportive and collaborative senior teammate and junior leader on you team and in Membership Accounting. 17. Performs other duties and projects 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.