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Job Details

Membership Accounting Specialist

Company name
Oregon Dental Service

Portland, OR

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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.

Currently, Moda Health is seeking a Membership Accounting Specialist. This position will be responsible for timely, accurate data entry and maintenance of Medical and Dental member eligibility, member and billing reconciliation, customer service to assigned groups or accounts, and generation of ID cards for all Moda Health and BHS lines of business including; Individual, Medicare, Medicaid, (CCO and DCO) and Employer Group customers of all sizes (ASO and Fully insured) COBRA and TPA accounts.

Primary Functions:

1. Responsible for eligibility and enrollment procedures daily via paper enrollment, electronic file, web based transactions, email enrollments, and sending welcome packet to our new members for all Moda and BHS products and lines of business.

2. Ensure the accuracy and timeliness of entering enrollments within the department, Employer Groups, State and Federal standards depending on Product and Line of Business.

3. Responsible for following delinquency policy and procedures to ensure both compliance and timely receipt of administrative fees and premiums.

4. Ensures all member, premium and administrative fees are reconciled on a monthly basis to the penny.

5. Maintains confidentiality of all information related to members, employer groups, employees and as appropriate, other information.

6. Highly motivated and able to take initiative, demonstrated ability to identify and solve problems.

7. Responds to all internal and external customer inquiries regarding enrollments, ID cards and attends customer meetings as requested by Sales and Account Services.

8. 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.

9. 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. Performs other duties and projects as assigned.

15. Be a supportive and collaborative teammate.

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.

Required Skills

1. High school diploma or equivalent.

2. Previous experience and/or knowledge of Facets preferred.

3. A minimum of 3 years’ experience preferred in fast paced business, data entry, customer service, enrollment, billing and reconciliation environment.

4. Computer proficiency with Microsoft Office applications particularly Excel and Word.

5. Ten key proficiency of 135 kpm on a computer numeric keypad/calculator preferred.

6. Typing proficiency of 25 wpm preferred.

7. Strong analytical, problem solving, decision making, organizational and detail oriented skills.

8. Strong verbal, written and interpersonal communication skills.

9. Ability to be courteous, patient and communicate with Moda Health and BHS members, Moda Health and BHS employees and Employer Groups in a positive and productive manner.

10. Maintain confidentiality and project a professional business image.

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© Health Services Group

Health plans in Oregon, Washington and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service. Dental plans in Alaska provided by Oregon Dental Service dba Delta Dental of Alaska.

Company info

Oregon Dental Service
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Company Profile
At Moda Health, we’re passionate about helping you on your journey to be better. We know that dealing with health concerns can be tough – and that it is a juggling act to fit in healthy choices every day. That’s what we’re here for. We’ll be your guide, your supporter, your fan club and your partner ready to help you every step of the way.

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