Note: The job is a remote job and is open to candidates in USA. Moda Health is a company committed to quality healthcare and community support. They are seeking a Membership Account Quality Analyst to provide quality assurance auditing of enrollment, billing, and reconciliation functions performed by Membership Accounting specialists.

Responsibilities

• Audit enrollments, billings and reconciliation daily using statistically valid sampling methodology, using prescribed audit criteria. Performs simple adjustments as necessary
• Ensures departmental quality assurance standards, employer group Statement of Work, and State and Federal Regulations are adhered to through auditing all Membership Accounting Specialist duties
• Conduct in-depth enrollment, billing, and reconciliation on performance groups, as well as focused audits for specifically identified situations or specialists on a scheduled basis
• Prepares required monthly and/or quarterly reports for specific group performance guarantees, production, and accuracy results
• Identify trends from audit results and recommend improvements to increase overall quality
• Creates and updates documentation, department procedures, and resource materials as needed
• Responsible for quality and continuous improvement within job scope
• Contributes to and supports the company’s quality initiatives by encouraging team and individual contributions toward the company’s quality improvement efforts
• Fosters an atmosphere of team spirit and portrays an outgoing and positive attitude with peers, Moda and BHS Leadership, Customers, trainees, and Specialists
• Responsible for regularly scheduled operational audits of staff members for your respective team and product line
• Other duties as assigned

Skills

• High School diploma or equivalent required
• 1-2 years quality review experience in a health insurance environment, preferably in a Membership Accounting (enrollment, billing & reconciliation) department preferred
• Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player
• Knowledge of Word, Excel, and ability to navigate web-based programs
• Excellent reading, verbal, and written communication skills, and the ability to interact professionally, patiently, and courteously with others
• Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities
• Ability to come in to work on time and on a daily basis. Maintain attendance above company standards
• Maintain confidentiality and project a professional business presence and appearance

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Company Overview