Top 325 Resources administrator Jobs in Gladstone, Or

Medicaid Provider Relations Representative II
Moda Health —Portland, OR
- $54,668.32 - $68,340.67 a year
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
20h
SENIOR HUMAN RESOURCES SPECIALIST | Probationary | 8 Hrs | Human Resources Department
Beaverton School District 48J —Beaverton, OR
- $92,742.72 - $122,228.25 a year
- Office
- Senior level
- Health insurance
- Dental insurance
2d
Academic & Career Coach [Part-Time]
Clackamas Community College —Oregon City, OR
- $26.18 an hour
- Part-time
- Background check
- Spanish
- Customer service
Office Administrator
Environmentally Conscious Recycling —Portland, OR
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Instructional Assistant I - Special Education
Gladstone School District —Gladstone, OR
- $21.14 - $30.06 an hour
- Part-time
- School experience
- Classroom
- Experience working with individuals with disabilities
7d
Leave and Benefits Specialist
Precision Castparts Corp. —Clackamas, OR
- Full-time
- Microsoft Excel
- Computer literacy
- Mid-level
- Paid time off
Payroll Administrator
BIOTRONIK SE & Co. KG —Lake Oswego, OR
- Weekends as needed
- Hybrid work
- Mid-level
- Office
- Finance
- Work from home
Market Center Administrator / Bookkeeper
Keller Williams Portland Central —Portland, OR
- $65,000 - $75,000 a year
- Full-time
- Computer literacy
- No experience needed
- Mid-level
- Paid training
- Health insurance
Quick Apply
10d
HR Administrator - $28.06/hour
Do Good Multnomah —Portland, OR
- $28.06 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid time off
Quick Apply
6d
Executive Office Administrator
Cat Adoption Team —Sherwood, OR
- $28 - $36 an hour
- Full-time
- Google Workspace
- Clean driving record
- Customer service
6d
Secondary Registrar Secretary (10038)
Evergreen Public Schools —Vancouver, WA
- $31.84 - $38.20 an hour
- 8 hour shift
- High school
- Writing skills
- Basic math
- Health savings account
- AD&D insurance
3d
Payroll Administrator
BIOTRONIK —Lake Oswego, OR
- Weekends as needed
- Hybrid work
- Mid-level
- Office
- Finance
- Work from home
Program Administrator 1
Oregon Health & Science University —Portland, OR
- $63,772 - $101,899 a year
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
8d
Counselor - Secondary
Gladstone School District —Gladstone, OR
- $57,680 - $108,610 a year
- Full-time
- Classroom
- High school
- Computer literacy
13d
Bookkeeper
Zenith-American —Tualatin, OR
- Full-time
- Computer literacy
- Mid-level
- Office
- Health insurance
- Dental insurance
9d
Office Administrator
Monkeyman's Tree Service —Lake Oswego, OR
- $20 - $25 an hour
- Full-time
- Google Workspace
- Customer service
- Basic math
- Paid holidays
- Health insurance
Quick Apply
7d
HR Payroll Administrator
Western Partitions, Inc. —Lake Oswego, OR
- Background check
- Mid-level
- Office
- Paid holidays
- Health insurance
Quick Apply
13d
Academic Labor Relations Specialist
Portland State University —Portland, OR
- $61,620 - $65,500 a year
- Weekends as needed
- Background check
- Bachelor of Science
- Administrative experience
- Health insurance
Sales & Events Operations Administrator
Hyatt Regency Portland Convention Center —Portland, OR
- $23.40 an hour
- Full-time
- Mid-level
- Hotel
- Continuous improvement
- Paid holidays
- Health insurance
13d
IT Technician
Trillium Family Services —Portland, OR
- $25 - $27 an hour
- Full-time
- Customer service
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
7d

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Medicaid Provider Relations Representative II

Moda Health
Portland, OR

Quick Apply

Job Details

Full-time
$54,668.32 - $68,340.67 a year
20 hours ago

Benefits

Paid holidays
Health insurance
Dental insurance
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
401(k) matching

Qualifications

Customer communication
Contract review
Microsoft Excel
Provider enrollment for medical credentialing
Contract interpretation
Contract management experience in healthcare
Medicaid health insurance
Check payment processing
Health policy
Data interpretation
Conducting training sessions
Meeting facilitation
Networking through strategic partnership building
Medicaid regulations
Medicaid
Productivity software
Data validation
Strategic partnerships
Healthcare reimbursement methods
DRG

Full 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
This is a FT hybrid position based in Portland, Oregon. This position provides concierge customer service to providers by being the liaison between the Medicaid plans. The Provider Relations Representative is responsible for presenting, promoting, and resolving concerns and issues brought forward by providers and internal staff and develop, improve, and streamline existing provider policies with the goal of removing barriers to providing care. This role will also implement projects and policies that impact providers (includes drafting communications, frequently asked questions, resource guides) to support network needs and promote strong, collaborative relationships. This role will also plan, prepare, and develop training materials for contracted providers and will conduct face-to-face trainings throughout the year. Internally, this role will work closely with our Lead Medicaid Provider Relations Representative for other Medicaid lines of business, multiple departments and is a critical role in supporting daily operations.

Pay Range
$54,668.32 - $68,340.67 salary (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.

https://j.brt.mv/jb.do?reqGK=27775587&refresh=true

Benefits:

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

Required Skills, Experience & Education:

Three or more years of provider relations experience.
Requires expertise in industry practices, specialized payment methodologies, Value Based Care agreements, Payer/Provider Strategic Partnerships, and all relevant regulations.
College degree in health care, business, analytics, or related field, or equivalent work experience.
Knowledge of Medicaid claims and benefits.
Proficient in identifying and interpreting Oregon Administrative Rules, CCO and provider contracts
Knowledge of provider payment methodologies including capitation, DRG, CAH and other facility and professional pricing.
Ability to analyze and validate provider claims and payment data.
Experience in manual processing of high dollar checks.
Judgement, self-motivation, and the ability to work independently, and as part of a team.
Is detail oriented and possess strong analytical, and problem-solving skills.
Skilled at delivering trainings and facilitating meetings.
Strong interpersonal communication skills and the ability to develop effective relationship with
network providers, members, and partners.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Must be willing to travel for provider training sessions.
Knowledge of Oregon’s Coordinated Care Organization (CCO) Infrastructure.
Must be able to represent the organizations at outside meetings, conferences, and events in a positive
and professional manner.
Must maintain confidentiality and project a professional business image.

Preferred Skills, Experience & Education:

Knowledge of medical office workflows.
Knowledge of other Moda Health products, plans, and networks.

Primary Functions:

Assist leadership in negotiating Single Case Agreements; review contract terms to ensure they can be operationalized.
Validation of bi-annual Delivery System Network (DSN) Report in partnership with analytics.
Assists with state, federal and other entity related audits.
Contract configuration, implementation, validation, and assessment.
Implement and coordinate new Medicaid provider focused initiatives.
Identify root causes of claim problems and trends and participate in developing solutions. This includes performing research through available systems, policies, and departments, ensuring timely resolution is achieved.
Work in a consultative role with various departments creating effective processes and updates.
Review and update Medicaid provider manuals, policies and procedures as well as desk manuals.
Oversight and management of Medicaid provider webpage content.
Utilize best practice policies and procedures, work guides or tools to provide improved department process workflows.
Coordinate and participate in targeted provider meetings, including annual Provider Workshops.
Educate providers on Oregon Administrative Rules and contract language ensuring consistent interpretation.
Provide timely responses to all provider inquiries, within two to three business days.
Provides ongoing support to the Medicaid Operations team.
Process provider enrollment applications and meet timelines established by management.
Complete and validate Medicaid encounter data.
Conduct on-site provider visits to create strategic provider partnerships to improve health efficiencies, and foster provider experience.
Attend State and other Medicaid related meetings to learn about new policy and initiative changes that have an impact on operations.
Perform other duties and special projects assigned.

Working Conditions & Contact with Others

Position is hybrid, based in Portland Oregon. Extensive close PC and keyboard work. Occasional require travel to off-site meetings which may include overnight stays.
Internally with multiple departments. Externally with providers, providers staff, office administrators, external partners, Oregon Health Authority staff.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our [email protected] email.

Pay: $54,668.32 - $68,340.67 per year

Benefits:

401(k) matching
Dental insurance
Flexible spending account
Health insurance
Paid time off
Vision insurance

Application Question(s):

Are you able to commute to Moda's Downtown Portland office three days per week to satisfy the hybrid requirement?
Do you have a college degree in health care, business, analytics, or related field, or equivalent work experience?

Experience:

Provider Relations : 3 years (Required)

Work Location: Hybrid remote in Portland, OR 97204

Quick Apply

Refine Your Search

resources administrator jobs in gladstone, or

Medicaid Provider Relations Representative II

SENIOR HUMAN RESOURCES SPECIALIST | Probationary | 8 Hrs | Human Resources Department

Academic & Career Coach [Part-Time]

Office Administrator

Instructional Assistant I - Special Education

Leave and Benefits Specialist

Payroll Administrator

Market Center Administrator / Bookkeeper

HR Administrator - $28.06/hour

Executive Office Administrator

Secondary Registrar Secretary (10038)

Payroll Administrator

Program Administrator 1

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Bookkeeper

Office Administrator

HR Payroll Administrator

Academic Labor Relations Specialist

Sales & Events Operations Administrator

IT Technician

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