Employment Type:

Full time

Shift:

Day Shift

Description:

At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

The Provider Service Specialist responds in a timely and accurate manner to provider inquiries made by phone, in person and in writing regarding Plan benefits, services and payment determinations.

Responsibilities

• Receive, interpret and accurately respond to provider inquiries, both verbally and in writing in accordance with department standards, policies and procedures.
• Consistently document and accurately code all inquiries within designated software applications, within required Plan timeframes and according to Plan documentation policies
• Review, investigate and advise providers regarding claims status and payment determinations
• Maintain a comprehensive knowledge of plan benefits, services and stay abreast of changes from year to year
• Document and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutions
• Interact professionally, efficiently and effectively with providers, management and other departments in a caring and honoring manner.
• Assist other internal departments as needed and assigned in support of Plan operations
• Responsible for both incoming and outgoing provider phone initiatives.
• All other duties as assigned.

Requirements

• Education: High School diploma or equivalent required
• Experience: 2-3 years of prior customer service experience required
• Managed Care Industry knowledge or experience preferred
• Knowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 coding
• Ability to function well in high pressure situations with attention to detail and accuracy

Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.