Employment Type:
Full time
Shift:
Day Shift
Description:
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
The Coordinator, Utilization Management Intake performs duties to support the Utilization Management department including management of internal and external calls, managing/triaging all departmental authorization/referral requests and assisting in compliance-driven auditing and reporting.
What You Will Do:
Assists with the management of departmental processes, auditing and reporting deliverables and initiatives in compliance with federal and state regulatory agencies.
Receives, interprets and responds to evaluation utilization review inquiries
· Manages incoming medical records, authorization requests and referrals for department.
· Manages department call tracking system and triage incoming calls as appropriate.
· Coordinates, oversees, records and transmits information pertinent utilization review processes.
· Assists with administrative responsibilities such as meeting preparation, minutes, mailings faxing/scanning department records, ordering of departmental supplies, etc.
· Responsible for performing a variety of tasks requiring independent judgement and initiative.
· Establishes and maintains effective working relationships with other departments.
· Establishes and maintains strong positive communication with key stakeholders.
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Minimum Qualifications:
Education : High School required; Bachelor's degree preferred
· Experience: Minimum of two (2) years data entry experience, with healthcare field preferred.
· Effective Communication Skills
· Understanding of medical terminology required.
· Must have in-depth computer skills including word processing software (e.g. Microsoft
Office) and data entry.
· Ability to work independently with minimal supervision.
· Must be able to document data accurately into computer system, and maintain statistical
records and reports.
· Must possess a high degree of motivation, initiative and organizational ability.
· Familiarity with managed care and claims processing required, including CPT & ICD-10
· coding, phone triaging, referrals and authorizations.
· Must be able to maintain confidentiality of work documents.
· Knowledge of managed care issues related to utilization management, plan benefits and provider contacts.
· Ability to work with physician offices in facilitating authorizations.
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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, 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.
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.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 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.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran
