Employment Type:

Full time

Shift:

Day Shift

Description:

Successful candidates will have a strong understanding of Medical claims particularly within Medicare guidelines.
Researching claims that do not process as expected and overseeing any necessary configuration changes.
Reviewing CMS notifications and assuring any necessary updates are done timely.
Reviewing provider contracts to make sure they are set-up correctly in the system.
Loading new codes into the system and making sure those codes are added to any applicable benefits.

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.

Position Purpose

Contracts/Benefits Configuration Specialist position performs a variety of analytical and configuration functions relating to contracts/benefits within the adjudication platform. Works collaboratively with other areas within the Health Plan to determine the needed changes as well as the impact on other areas. Responsible for issue resolution and testing changes.

What you will do

• Serves as a primary expert within the Health Plan for configuration and maintenance of contracts, fee schedules and benefits

• Assists in developing provider contracts, fee schedules and benefits to ensure efficient implementation and administration

• Test and document all configuration changes to ensure no adverse impact on other areas

• Develops and performs audits as needed to ensure effective administration of contracts, fee schedules and benefits

• Maintains and in-depth working knowledge of all facets of the adjudication platform

• Uses ad hoc reporting and analysis to assess appropriate configuration or process improvement

• In conjunction with the 3rd party vendor, create/maintain DLT's for claims processing staff

Minimum Qualifications

• ·Education: Associate or Bachelor's degree preferred

• ·Experience: 5 years medical claims or relevant health insurance

• In depth understanding of Medicare & Medicare Advantage.

• Excellent organizational and planning skills, including the ability to prioritize multiple task and perform accurately, timely and simultaneously.

• Ability to help develop, interpret and implement provider contracts, fee schedules, and member benefits.

Position Highlights and Benefits:

• Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
• 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 starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• 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 five 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!

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color,