Provider Service Specialist Remote Seasonal MediGold

Employment Type:Full time

Shift:Day Shift

Description:This position is a full time temporary position. The position is to begin 8/10/2025 and to end 04/04/2026

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.

About the job:

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.

What you'll do:

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

Demonstrate effective use of departmental software and technical systems

Responsible for both incoming and outgoing provider phone initiatives.

What we're looking for:

Education: High School diploma or equivalent required

Experience: 2-3 years of prior customer service experience required

Managed Care Industry knowledge or experience preferred

Ability to work independently with minimal supervision and also as a team.

Knowledge of and/or the ability to do data entry, various claim form formats, medical terminology, CPT and ICD9 coding

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million 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 outreach 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 make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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.

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