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Temporary Operations Resolution Specialist MCHP – Provider Data Management remote

May 26, 2026

<h2>Employment Type:</h2>Full time<h2>Shift:</h2><h1>Description:</h1>This is a temporary, full‑time position with an expected duration of 3monthsWhy MediGold? <a href="https://medigold.com/" target="_blank" rel="noopener noreferrer">MediGold</a> 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: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 use of discretionary discernment with sensitive materials. Serves as 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 Medicaid and 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 identification of root causes regarding any discrepancies found in the provider data while working alongside all other Operations Resolution Specialists across the plan to fully resolve issuesWhat you will do:<ul><li>Preparation of all initial direct and delegated credentialing rosters for automated Provider Data Load (PDL) process</li><li>· Process rejection reports from PDL process and correct any errors discovered</li><li>· Education of CIN, groups, etc. for future expansion regarding direct and delegated roster formats to ensure accurate PDL</li><li>· Internal audit (monitoring) of Provider Data, such as demographic changes, TIN adds, provider terms, etc.</li></ul>Minimum Qualifications:<ul><li>Education: Associate or Bachelor’s degree preferred.</li><li>· Certification: N/A</li><li>· Experience: One to three years experience preferred in either managed care health insurance.</li><li>· Effective Communication Skills.</li><li>· Strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customer.</li><li>· Analytical and problem-solving skills.</li><li>· Experience in use of computer systems and office automation applications.</li><li>· Knowledgeable with provider credentialing and contracting terminology.</li><li>· Basic knowledge of healthcare claims process.</li></ul><ul><li></li></ul>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.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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