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Provider service specialist medigold corporate services center job

Mount Carmel Health jobs




Company Description

Mount Carmel Health System operates a chain of outpatient facilities and four hospitals that include Mount Carmel East near Reynoldsburg, Mount Carmel Grove City in Grove City, Mount Carmel St. Ann's in Westerville and Mount Carmel New Albany Surgical Hospital in New Albany, serving the communities of Ohio. The healthcare centers are driven by its fundamental values to operate its people-centered services by providing free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care, and specialty care physician offices, community outreach sites, and homes across the region. Committed to high-quality care, the system has continued its reputation, winning numerous awards and national recognition for clinical performance and patient experience. The system, with its highly trained professional employees, are actively involved with all operations the system undertakes, comprising over 10000 employees, 2000 physicians, and numerous volunteers, and uncompensated benefits are available to these individuals and future employees under the system.

Job Description

Department:17600_80413 MCHP-Provider ServicesExpected Weekly Hours:40Shift:Day ShiftPosition Purpose:Provider Service Specialist – MediGold – M4215 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. Details: 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 policiesReview, investigate and advise providers regarding claims status and payment determinationsMaintain a comprehensive knowledge of plan benefits, services and stay abreast of changes from year to yearDocument and track actions requested from other departments addressing provider or member inquiries and informal complaints to insure prompt resolutionsInteract 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 operationsResponsible for both incoming and outgoing provider phone initiatives.All other duties as assigned. Requirements Education: High School diploma or equivalent requiredExperience: 2-3 years of prior customer service experience requiredManaged Care Industry knowledge or experience preferredKnowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 codingAbility 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, physical disability or any other classification protected under local, state or federal law. Trinity Health's Commitment to Diversity and Inclusion Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 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.
Estimated annual salary
Health Insurance

Mount Carmel Health






$1B to 2B


Multiple locations



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Surgical TechMount Carmel Health SystemWesterville, OH
Employment Type: Full time Shift: Rotating Shift Description: Surgical Technician - Inpatient Surgery Mount Carmel St. Ann's Why Mount Carmel? With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan...Read more
Employment Type:Full timeShift: Description: Why Mount Carmel? With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health...Read more
Certified Pharmacy Technician II (Part-Time / Evenings)Mount Carmel Health SystemColumbus, OH
Employment Type: Part time Shift: Rotating Shift Description: This position is located at Mount Carmel East Hospital. Why Mount Carmel? With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and...Read more
Surgical Technician - Inpatient SurgeryMount Carmel Health SystemWesterville, OH
Employment Type:Full timeShift:Rotating Shift Description: Surgical Technician - Inpatient Surgery Mount Carmel St. Ann's Why Mount Carmel? With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and...Read more
LPN, Licensed Practical Nurse - Emergency Department - DaysMount Carmel Health SystemWesterville, OH
Employment Type:Full timeShift:12 Hour Day Shift Description: Will be working three 12-hour shifts per week from 7am - 7:30pm with rotating weekends and holidays in the Emergency Department at Mount Carmel St. Ann's. Qualified applicants may submit a...Read more

Closed Job Filters

Neuro hospitalist opportunity columbus, ohMount Carmel HealthColumbus, OH
Location: Columbus, Ohio, , United StatesPosted: 2019-12-20Position Title: Neuro Hospitalist Opportunity Columbus, OHCompany Name: Mount Carmel Health SystemSector: MedicalJob Duration:Read more
Lpn, licensed practical nurse - emergencyMount Carmel HealthWesterville, OH
Location: Emergency Department Mount Carmel St. Ann's Qualified applicants may submit a resume to Laura Mangia, Senior Talent Acquisition Partner at lmangia@mchs.com for expedited consideration WhyRead more
Director, med surg servicesMount Carmel HealthColumbus, OH
Location: Mount Carmel East Hospital Qualified applicants may submit a resume to Senior Talent Sourcing Partner Ashley Rogers at Ashley.Rogers002@mchs.com for expedited consideration Why Mount Carmel?Read more
Qualified applicants may submit a resume to Talent Sourcing Partner Tyler Page at tyler.page@mchs.com for expedited consideration Why Mount Carmel? With five hospitals, over 60 free-standingRead more
Rn, registered nurse - interventional radiologyMount Carmel HealthWesterville, OH
Qualified applicants may submit a resume to Senior Talent Acquisition Partner Amber Bates at abates@mchs.com for expedited consideration $7,500 Sign-on Bonus available to candidates with at least twoRead more
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