Coding and Reimbursement Specialist

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. 

Position Purpose:

Coding and Reimbursement Specialist, 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.

Minimum Qualifications:

• Education Requirement: High School degree required.  Bachelor's degree preferred.
• Licensure Requirement: CPC, CPC-P or equivalent preferred
• Minimum of 5 years experience in claims auditing, billing and/or coding.
• Must possess an in-depth knowledge of current Medicare coding and billing requirements
• Must be knowledgeable in multi-specialty coding and billing requirements
• Must possess extensive knowledge of auditing concepts and principles
• Advanced knowledge of current medical terminology, anatomy and physiology required.
• Advanced knowledge of current ICD-10, CPT-4, and HCPC coding principles and documentation guidelines
• Extensive knowledge of Medicare regulations and policies pertaining to documentation, coding and billing
• Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers, including but not limited to, physicians, practice managers, billing managers and billing staff at all levels, including the ability to articulate complex regulatory information in layman's terms.

What you'll do:

• Review and respond to post-payment inquiries from providers
• Process pended claims to ensure integrity of claim payment to providers and members
• Work with provider credentialing to ensure proper set-up in order to allow for accurate payments
• Process and review requests from member for reimbursement
• Proactively identify, through auditing and internal reporting, trends.  Develop and present reports of findings to Health Plan leadership
• Develop and maintain an effective working relationship with providers and their billing staff
• Performs responsibilities of Claims Auditor as time and work load permit and dictate
• Assist in the development of tools and presentations on documentation, coding, billing, and other topics of interest to our provider community
• Attend coding and billing conferences, workshops and in-house education sessions to stay current with coding and billing regulations
• Analyzes claims processes to identify potential areas of fraud, waste and abuse.  Provides recommendations to improve processes
• Assist with the release of claims pended for coding issues

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

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 four 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!

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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.

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.