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.

Job Summary:
As part of the Medicare Compliance team, the Analyst contributes to Moda’s compliance program by researching and analyzing applicable laws, rules, regulations, and guidance. This role supports business areas and other entities in achieving and maintaining compliance, along with performing related tasks.   This is a FT hybrid position based in Portland, Oregon.

Pay Range
$64,394.27 - $80,498.01 (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.

Benefits :

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

Primary Functions:

1. Research applicable laws, rules and regulations; assist business areas in achieving and maintaining compliant processes, communications, and documentation.
2. Create Medicare materials closely following Medicare guidance and model documents.
3. Verify completion of required compliance training by employees, Board members and delegates; ensure individuals are not excluded from participation in federal programs.
4. Manage the implementation of new CMS memos, including review, interpretation, distribution, documentation, and tracking of successful implementation.
5. Develop and deliver educational classes related to Medicare regulation and guidance updates.
6. Monitor compliance of internal departments and vendors; collaborate to address identified gaps and risks.
7. Oversee delegated entity compliance, including chairing the vendor review committee, soliciting compliance attestations, conducting vendor audits, and serving as a compliance resource.
8. Manage responses to reports of noncompliance, including investigation of root causes, assisting with corrective action plans, and documentation.
9. Conduct routine and targeted internal audits and monitoring activities to evaluate compliance with Medicare program requirements.
10. Support CMS audits and mock audits, including data collection, universe file validation, and documentation review.
11. Maintain thorough documentation of monitoring activities, audit results, and compliance-related investigations.
12. Assist in maintaining policies, procedures, and training materials in line with regulatory updates.
13. Support the annual risk assessment and work plan process.
14. Other duties as assigned.

 

Required Skills & Experience:

1. Bachelor’s degree or equivalent combination of education and/or relevant business experience.
2. Experience in insurance operations; Medicare Part D compliance experience preferred.
3. Strong knowledge of Medicare regulations.
4. Ability to interpret Medicare regulations and provide actionable guidance and education.
5. Excellent written and verbal communication skills.
6. Demonstrated analytical skills and high attention to detail.
7. Project management capabilities.
8. Ability to build and maintain effective business partnerships to support Medicare compliance.
9. Proficiency with software tools used for developing, maintaining, and utilizing tracking/database mechanisms.
10. Ability to maintain confidentiality and project a professional business image.

 

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.
• Internally with multiple departments.  Externally with government regulatory agencies, business partners, and customers as needed.

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 humanresources@modahealth.com email.

Job Tags

Holiday work, Full time, Remote job, Afternoon shift,

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