Moda Health Hiring for Dental PR Representative- Remote Job at Portland, OR Full Time

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.

We are seeking a Dental Professional Relations Representative. This position is responsible for claims in professional relations queues; investigate and resolve provider inquiries; create and maintain dental agreement configuration for accurate claims processing.

Training will be conducted in office for first 3 months. After training the position will open up to be remote.

Primary Functions:
01. Provide customer service for providers and office staff inquiries.
02. Create and maintain Oregon and Alaska provider files in internal systems, provider database and National Provider File – add missing information, correct provider tax identification number (TIN) and other general corrections or updates for commercial and OHP providers.
03. Manages all facets of setting up dental clinics ensuring current and accurate data for all associated providers.
04. Assist providers with filing their fees.
05. Maintain provider participation network status in internal systems, provider database.
06. Establish electronic files in Content Manager for all provider records, participating agreements, fees, credentialing and correspondence.
07. Track credentialing and re-credentialing process for all providers.
08. Respond to Oregon and Alaska providers for establishing participating agreements.
09. Manage claims in professional relations queues.
10. Responsible for responding to emails with both internal and external users.
11. Responsible for setting up weekly 835 requests for EFT/ERA requests from EDI department.
12. Problem solve for provider issues working with other Delta member companies and Moda/Delta Dental claims department for resolution.
13. Maintain accuracy of dental network directory listings.
14. Manage provider OHP eligibility status for DMAP submissions of 3108 enrollment forms.
15. Participate and contribute to various committees that are related to job role.
16. Address and resolve Taxpayer Identification Numbers (TIN) with providers and Moda accounting.
17. Network recruitment as needed.
18. Other duties as assigned, such as special projects.

This position is within an office environment. Applicants must navigate multiple screens and be comfortable with extensive close PC, keyboard, and phone work. Work can be in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business needs.

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.