OHP Coordinator I Job Title OHP Coordinator I Duration Open until filled Description Let’s do great things, together! About ModaFounded 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 SummaryThe OHP Dental Coordinator I is a member of the dental case management team. Responsibilities include assisting members with special health care needs access dental care, completing specialist referrals, outreach to members that seek care in the emergency department for dental reasons, assisting members and providers with missed appointment and dismissal patterns, and coordinating on-site interpreter requests. The OHP coordinator stays current with all Medicaid dental benefits and provides training to the customer service representative on all Medicaid related issues. The OHP coordinator works closely with contracted Coordinated Care Organizations (CCOs) as well as internal departments including dental professional relations and dental customer service. The coordinator works closely with the quality initiatives specialist to ensure Oregon administrative rules are implemented appropriately. The coordinator maintains accurate records of all case management for reporting for internal and contractual requirements. This is a FT WFH position based in Portland, Oregon. Pay Range $22.43 - $28.05 ​​​hourly (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=27746492&refresh=trueBenefits: + Medical, Dental, Vision, Pharmacy, Life, & Disability + 401K- Matching + FSA + Employee Assistance Program + PTO and Company Paid Holidays Required Skills, Experience & Education: + College degree or equivalent. + 2 – 4 years dental claims, dental customer service, or dental office experience preferred. + PC proficiency with Microsoft Office applications. + Knowledge and understanding of the Oregon Medicaid program mandates and administrative policies preferred. + Strong analytical, problem solving, organizational and detail orientation skills. + Excellent verbal, written, presentation and interpersonal communication skills. Must be able to communicate with internal and external contacts in an effective and diplomatic way. + Ability to be a self-starter and work independently with little supervision. + Ability to meet deadlines and work efficiently under pressure in a complex and rapidly changing environment. + Ability to come in to work on time daily. + Maintain confidentiality and project a positive, professional business image. + Demonstrate ability to multi-task and be flexible with multiple OHP duties. + Ability to handle stressful situations as well as having good judgment and decision-making skills. + Work well under pressure with frequent interruptions and shifting priorities. + Ability to back up supervisor, answer questions from dental customer representatives, assist in training or orientation and complete reports. + Ability to identify, justify, and implement process improvement projects. Primary Functions: + Process all OHP referrals received from providers by telephone, mail, email, and fax. This includes gathering x-rays and chart notes if necessary, requesting management approval, entering the case in the dental case management database, and updating Facets with referral information. + Maintain a comprehensive knowledge of all OHP benefits, limitations, frequencies, and exclusions. + Review all OHP complaints and appeals as entered in Facets by customer service representatives prior to review by appeals coordinator to ensure all required information was entered appropriately. + Review and revise all dental customer service OHP provider and member letters to ensure information is current and meets DMAP requirements. + Update existing and prepare new Medicaid and CCO related UPM pages and CIS notes as needed. + Create and update documentation and resource materials as needed. + Attend quarterly DQIC meeting. Prepare all dental customer service reports for this meeting and present reports to the committee. + Participate in the annual OHP provider and member handbook review. + Interact with dental professional relations and quality specialist as needed for provider access, interpretation of OARs and other OHP related issues. + Complete member assignment requests for dental and provider changes. + Manage cases related to special health care needs: include but not limited to pregnancy, diabetes, heart conditions. + Attend and participate in recurring meetings with CCOs related to care coordination and case management, as assigned + Meet or exceed department standards and follow defined desk top processes. + Performs additional duties as assigned. Special Projects as Assigned + Access Pre-Manage for members seen in the emergency department for dental treatment and enter member cases for case management. Attend meetings with CCOs regarding Pre-Manage and processes for specific case management. Provide on-going reports to CCOs and internal committees. + Monitor all children recently placed in to foster case and enter member cases for continued case management. Attend meetings with CCOs regarding foster children and shared processes for best practices. Provide weekly and monthly reports to CCOs and internal committees. + Audit OHP customer service calls as requested by supervisor + Maintain a current and accurate list of OHP providers and specialists by county for use in the dental customer service department. Consult with dental professional relations regarding provider participation as applicable. + Provide comprehensive OHP training for new customer service representatives. Provide ongoing training to customer service department as needed. This includes preparation of curriculum, reference materials, and conducting the training. + Primary subject matter expert for DCO/CCO integration. Prepare a training program for dental customer service representatives, leads, and supervisors on all aspects of Moda OHP DCO/CCO integration. Working Conditions & Contact with Others + Office/home office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Occasionally work in excess of standard work week to meet business need. Travel to off-site meetings. + Internally with multiple departments; externally with CCOs, OHP program staff and providers, and members. 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 and Daniel McGinnis via our humanresources@modahealth.com email.