Temporary Operations Resolution Specialist MCHP – Provider Data Management remot
Mount Carmel Health System, Columbus, OH, United States
Description
This is a temporary, full-time position with an expected duration of 3 months.
Employment Type
Full Time
Position Purpose
Provider Data Management role manages the integrity 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 using discretionary discernment with sensitive materials. Serves as the department subject matter expert, requiring knowledge of plan systems, tools, policies and procedures, and acts as liaison with internal and external customers. The role will conduct audits to ensure compliance with the Centers for Medicare & Medicaid 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 identifying root causes regarding any discrepancies found in the provider data while working alongside all other Operations Resolution Specialists across the plan to fully resolve issues.
What You Will Do
Preparation of all initial direct and delegated credentialing rosters for automated Provider Data Load (PDL) process.
Process rejection reports from PDL process and correct any errors discovered.
Educate 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 managed care health insurance.
Effective communication skills.
Strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers.
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 healthcare claims process.
Equal Opportunity Employer Statement
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. 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.
#J-18808-Ljbffr
This is a temporary, full-time position with an expected duration of 3 months.
Employment Type
Full Time
Position Purpose
Provider Data Management role manages the integrity 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 using discretionary discernment with sensitive materials. Serves as the department subject matter expert, requiring knowledge of plan systems, tools, policies and procedures, and acts as liaison with internal and external customers. The role will conduct audits to ensure compliance with the Centers for Medicare & Medicaid 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 identifying root causes regarding any discrepancies found in the provider data while working alongside all other Operations Resolution Specialists across the plan to fully resolve issues.
What You Will Do
Preparation of all initial direct and delegated credentialing rosters for automated Provider Data Load (PDL) process.
Process rejection reports from PDL process and correct any errors discovered.
Educate 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 managed care health insurance.
Effective communication skills.
Strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers.
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 healthcare claims process.
Equal Opportunity Employer Statement
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. 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.
#J-18808-Ljbffr