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Encounter Resolution Specialist

Company: Trinity Health
Location: Columbus
Posted on: February 16, 2020

Job Description:

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 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 About the job: Claims Resolution Specialist, in a timely and professional manner, researches, analyzes, documents, and coordinates the resolution of escalated and/or complex claims issues. Serves as a department subject matter expert and requires knowledge of all Plan systems, tools, policies and procedures. The Claims Resolution Specialits will coordinate the identification of root causes involving claims payment, claims system configuration and/or provider contracting errors, and works with multiple operational areas across the Plan to fully resolve identified claims errors.The Resolution Specialist will also be the lead on completing dcoumented quality reviews for the Claims team and presenting results to management What you'll do: Partners with the Provider Services call center to determine claim trends and provides education and feedback related to escalated claims questions and issues Tracks provider claims escalation cases and/or projects on a weekly basis to ensure they stay on task and are resolved in a timely manner Works directly with the Provider Network Managers to fully resolve escalated provider claims disputes Prepares confidential correspondence/documentation for providers as necessary to resolve escalated claims disputes Reviews and responds to post-payment inquiries from providers in a timely and professional manner, in accordance with department standards, policies and procedures What we're looking for: Associate or Bachelor's degree preferred CPC, CPC-P or equivalent required 5 to 10 years experience in claims auditing, billing and/or coding or health plan experience preferred. Must possess in-depth knowledge of current Medicare coding and billing requirements Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers -- 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.

Keywords: Trinity Health, Columbus , Encounter Resolution Specialist, Other , Columbus, Ohio

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