Department:OH1CH_70505_000 MCHP-Claims Operations & System Configuration
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care.
Job Description Details:
MediGold is a not-for-profit Medical 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.
Our Coding and Reimbursement Specialist, in a timely and professional manner, responds to post-payment inquiries from providers regarding claim disposition; serves as a department resource; provides/develops educational resources for providers; and serves as the subject matter expert for the Plan in all matters related to provider billing and reimbursement.
- Prepares program specifications and diagrams and develops coding logic flowcharts.
- Analyzes and evaluates existing or proposed systems and devises computer programs to process data. Prepares charts and diagrams to assist in problem analysis and submits recommendations for solution.
- Formulates and defines system scope and objectives for assigned projects. Prepares detailed specifications from which programs will be written. Responsible for program design, coding, testing, debugging and documentation.
- Serves as a project resource for installation of new information systems processes or of modifications/enhancements to existing information systems. This includes: following defined procedures regarding the installation software and hardware, providing feedback to others responsible for monitoring project status, assuring system integrity, and preparing status reports for department management and all other Associates involved.
- Education: High School Diploma required. Associate or Bachelor's degree preferred.
- Licensure / Certification: Certification: CPC, CPC-P or equivalent required
- Experience: Minimum of 5 years' experience in claims auditing, billing and/or coding.
- Advanced knowledge of current ICD-9, CPT-4, and HCPC coding principles and documentation guidelines. Advanced knowledge of current medical terminology, anatomy and physiology required.
- Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately, timely, and simultaneously
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, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 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.