Resolution Specialist

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Resolution Specialist acts as a liaison between members, brokers, providers, and all internal departments serving as a contact for day-to-day support in all matters to ensure quality, accuracy and integrity is delivered to all counterparts. Resolves escalated issues related to operational inquiries across all lines of business including fully insured commercial business, third-party administrator business, and Medicare Advantage business. Maintains department performance standards, identifies trends and recommends areas for improvement and opportunities.

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! * More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements:

* High school diploma or equivalent; Associates degree preferred

* Minimum 3 years health plan claims experience, OR patient financial services OR Revenue Cycle experience (similar experience may be considered)

* 3-5 yrs customer service years preferred

* Versed in contract interpretation and the claims process for Medicare Advantage, PPOs & HMOs.

* Experience with Medicare Advantage, HMO, PPO, and self-funded products

* Ability to communicate complex program criteria into easily understood summaries in both or oral and written communication

* Strong analytical and critical thinking skills with an ability to design, track and work towards specific measurable performance targets.

* Familiar with designing and improving workflows for optimal efficiency

* Experienced and comfortable in public speaking arena

* Ability to impart knowledge/train external representatives and various internal departments and levels within the organization

* Must be able to deal with challenging customer situations in a professional manner.

* Ability to interpret and apply established policies and procedures.

* Excellent computer skills (Microsoft Office Suite with emphasis on Excel and Power Point).

* Must be a team player and have the ability to work independently with little supervision

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.