Provider Service Specialist - MediGold - Corporate Services Center Mount Carmel Health 336 reviews - Columbus, OH Department: OH1CH_70514_000 Mchp Provider Relations Expected Weekly Hours: 40 Shift: Day Shift Position Purpose: 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. Were 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. Job Description Details: 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. Trinity Health's Commitment to Diversity and Inclusion Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity. 1 day ago - save job - original job Apply On Company Site Other jobs you may like Wealth & Investment Service Specialist Huntington Bank - Columbus, OH 1 day ago Customer Service Specialist American Chemical Society - Columbus, OH 7 days ago Customer Service Experience Representative Accurate Mechanical Control Inc - Columbus, OH 9 hours ago Customer Service Specialist KAR Auction Services, Inc. - Columbus, OH 10 days ago Customer Service Representative Needed for Pa... U-Haul - Columbus, OH 1 day ago * Provider Service Specialist jobs in Columbus, OH * Jobs at Mount Carmel Health in Columbus, OH * Provider Service Specialist salaries in Columbus, OH Mount Carmel Health Mount Carmel Health 336 reviews At Mount Carmel, youll find an environment that inspires you to do your absolute best every day. Through our dedication to our mission,... Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume