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PAR - Provider Credentialing & Data Specialist II
Medical Mutual - Toledo, OH
Under general supervision, performs typically routine to moderately complex initial and ongoing practitioner, provider, and organization data entry and credentialing into the various modules of the Provider Data Management System. Ensures compliance with standards set by individual states, federal and accrediting organizations and meets production and quality metrics. ESSENTIAL FUN...
PAR - Medical Coding Compliance Specialist
Medical Mutual - Toledo, OH
Job Summary: Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with assigning and maintaining diagnoses medical codes. Evaluates requests for adherence to Company policies for the most precise medical codes. Audits vendors for quality assurance of risk adjustment coding f...
PAR - Claims Representative II
Medical Mutual - Toledo, OH
Job Summary: Processes claims in accordance with benefit contracts, plan policies and production/quality goal requirements. Performs administrative duties as requested by management. Responsibilities: Processes claims edits from receipt to completion and adheres to quality standards to meet Company and departmental goals.
PAR - Membership Services Specialist I
Medical Mutual - Toledo, OH
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individ...
