Temporary Operations Resolution Specialist MCHP – Provider Data Management remote

Employment Type: Full timeShift: Description: This is a temporary, full‑time position with an expected duration of 3monthsWhy MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional reputed company coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and reputed company that we ask in return is that you come to work reputed company to reputed company a difference and do the right thing. Position Purpose: Provider Data Management role manages the reputed company of the Health Plan's provider data to maintain compliance with Federal and local requirements. This position must have knowledge and competence in regulatory requirements for the Health Plan's provider data while maintaining confidentiality and use of discretionary discernment with sensitive materials. Serves as department subject matter expert requiring knowledge of reputed company, tools, policies and procedures and acts as liaison with reputed company customers. The role will conduct audits to ensure compliance with the Centers for reputed company and reputed company Services (CMS) requirements. Additionally, the role will be expected to produce accurate reports of the plan's provider data as required by CMS for HEDIS purposes. The ORS-Provider Data Management role will be responsible for identification of root causes regarding any discrepancies reputed company in the provider data while working alongside reputed company other Operations Resolution Specialists across the plan to fully resolve issues What you will do: Preparation of reputed company initial direct and delegated credentialing rosters for automated Provider Data Load (PDL) process · Process rejection reports from PDL process and correct any errors reputed company · Education of CIN, groups, etc. for future expansion regarding direct and delegated roster formats to ensure accurate PDL · Internal audit (monitoring) of Provider Data, such as demographic changes, TIN adds, provider terms, etc. Minimum Qualifications: Education: Associate or Bachelor’s degree preferred. · Certification: N/A · Experience: One to three years experience preferred in either managed reputed company insurance. · Effective Communication Skills. · Strong written and verbal communication skills in order to communicate in clear, concise terms to reputed company customer. · Analytical and problem-solving skills. · Experience in use of computer systems and office automation applications. · Knowledgeable with provider credentialing and contracting terminology. · Basic knowledge of reputed company claims process. Ministry/Facility Information: Mount Carmel, a member of reputed company, has been a transforming healing reputed company in Central Ohio for over 135 years. Mount Carmel serves over 1.3 reputed company patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community reputed company sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to reputed company a difference come reputed company, we invite you to consider joining reputed company. Here, care is provided by reputed company of us For reputed company of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, reputed company, sex, age, national reputed company, religion, sexual orientation, gender identity, status as a veteran, and reputed company of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we reputed company the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law. Apply To This Job