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Provider Relations Coordinator
2 months ago
Employment Type:
Full time
Shift: Day Shift
Overview:
At Trinity Health, we foster an environment of inspiration and inclusivity. Our culture of humility and compassion distinguishes us, as we prioritize the well-being of both our colleagues and the patients we serve.
MediGold, a not-for-profit Medicare Advantage insurance plan, is committed to delivering outstanding customer service, effective care, and exceptional healthcare coverage for seniors and other Medicare beneficiaries in Ohio.
As a Provider Relations Coordinator, you will respond promptly and accurately to provider inquiries made via phone, in person, and in writing regarding plan benefits, services, and payment determinations.
Key Responsibilities:
1. Receive, interpret, and accurately respond to provider inquiries, both verbally and in writing, adhering to departmental standards, policies, and procedures.
2. Consistently document and accurately code all inquiries within designated software applications, ensuring compliance with required plan timeframes and documentation policies.
3. Review, investigate, and advise providers on claims status and payment determinations.
4. Maintain comprehensive knowledge of plan benefits and services, staying informed of annual changes.
5. Document and track actions requested from other departments to address provider or member inquiries and informal complaints, ensuring prompt resolutions.
6. Interact professionally and effectively with providers, management, and other departments in a respectful manner.
7. Assist other internal departments as needed to support plan operations.
8. Manage both incoming and outgoing provider phone initiatives.
9. Perform all other duties as assigned.
Qualifications:
Education:
High School diploma or equivalent required.
Experience:2-3 years of prior customer service experience required. Managed Care Industry knowledge or experience preferred. Proficiency in data entry, various claim form formats, medical terminology, CPT, and ICD9 coding is essential.
Ability to thrive in high-pressure situations while maintaining attention to detail and accuracy is crucial. At Trinity Health, we believe in discovering opportunities, supporting excellence, and making a meaningful difference in patients' lives.
Trinity Health and its affiliates are proud to be equal opportunity employers, committed to diversity and inclusion. We do not discriminate based on race, gender, religion, sexual orientation, or physical ability.
Our diverse workforce enhances our ability to provide accessible and equitable care to those we serve.
