Provider Data Operations Jobs Near Me

Why 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 healthcare 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 all that we ask in return is that you come to work ready to make a difference and do the right thing. 

What we offer:

• Competitive compensation and benefits packages including medical, dental, and vision coverage

• Retirement savings account with employer match starting on day one

• Generous paid time off programs

• Employee recognition incentive program

• Tuition/professional development reimbursement

• Relocation assistance (geographic restrictions apply)

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

• Mount Carmel offers 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. You deserve to get paid every day!

Why Columbus?

The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest – ranked #1 for population growth, #1 for job growth, #1 for wage growth, and #1 real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more at www.experiencecolumbus.com!

About the job:

The Operations Resolution Specialist - Provider Data Management (PDM), ensures the timely and accurate entry of all add/changes/deletions to the Amisys Provider Database.  The PDM Specialist researches, analyzes, documents, and coordinates the resolution of escalated and/or complex provider data tasks.  Serves as department subject matter expert and requires knowledge of all Plan systems, tools, policies and procedures.  The PDM Specialist also assists and partners with Contracting and Credentialing teams with the identification of root causes involving the provider data issues related, but not limited to, claims payment, online directory, attribution, EFT/ERAs, and PCP terms.  This role is also accountable for the management of error reports generated as a result of the automated data load process. 

What you'll do:

• Maintain accurate entry/oversight of all provider database adds/change/deletes in a timely manner to ensure prompt and accurate claims administration and other Plan Reporting                                                            
• Manage process related to automated provider loads and resulting error/warning reports
• Coordinate needed work items related to Delegated Rosters and related entities  
• Perform needed audits to ensure accuracy of provider data setup                                            

What we're looking for:

• Education: High school education required. Associate or Bachelor's degree preferred.

• Experience: Five years experience preferred in either managed care health insurance, or customer service disciplines.

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.

Our Commitment to Diversity and Inclusion
 

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 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.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.