184 applicants

Company

Mount Carmel Health System · 7 hours ago

Operations Resolution Specialist - Provider Data Management MediGold- Remote

Columbus, OH

Full-time

Remote

Entry, Mid Level

1+ years exp

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Responsibilities

Responds to sensitive, escalated and difficult inquiries. Researches, resolves and responds to such inquiries in a timely, compliant and courteous manner.

Determines trends and provides education and feedback related to escalated questions and issues.

Coordinates the identification of root causes for errors and works with multiple operational areas across the Plan to fully resolve identified errors.

Generates reports as necessary to monitor processes.

Assists in the development and maintenance of department policies and procedures.

Functions as a team member by serving as a department resource and subject matter expert

Assists in the development of tools and presentations on documentation, coding, billing, and other requirements necessary for complete encounter data submissions

Works proactively with external vendors to troubleshoot encounter errors and correction of necessary inbound data

Qualification

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CPC CertificationClaims Processing KnowledgeProvider Credentialing KnowledgeManaged Care ExperienceCustomer Service ExperienceMedical Terminology KnowledgeAnatomy KnowledgePhysiology Knowledge

Required

CPC, CPC-P or equivalent required for Claims department.

Active State of Ohio Insurance License (Life and Health) or obtained within 90 days of hire for Member Services department.

Knowledgeable in provider coding and billing requirements.

Knowledgeable with provider credentialing and contracting terminology.

Basic knowledge of the healthcare claims process.

General knowledge of current medical terminology, anatomy and physiology.

Preferred

Associate or Bachelor's degree preferred.

One to three years experience preferred in either managed care health insurance, or customer service disciplines.

Benefits

Medical, dental, and vision with coverage starting on day one

Retirement savings account with employer match starting on day one

Generous paid time off programs

Employee recognition programs

Tuition/professional development reimbursement

Relocation assistance (geographic and position restrictions apply)

Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing

Employee Referral Rewards program

DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday

Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups