Digital Service Representative
The Digital Services Rep is responsible for a significant variety of critical functions necessary to support day-to-day claims operations which includes, but is not limited to, the following activities:
PRIMARY JOB RESPONSIBILITIES:
- Preparation of all paper claims requires detailed, robust knowledge of Delta, Commercial, Vision as well as State & Health Plan business clients, client requirements, claim & UM policies and procedures. The preparation of the paper claims includes:
- Identifying specific criteria to determine the correct claim type that accurately identifies the claim ( 8 possible determinations)
- Assuring that all corresponding documentation is digitized, as received, with each claim
- Assuring that all radiographs and orthodontic models are assigned a bar code matching the exact claim that those items must be associated with once loaded into the processing system.
- Digitizing of all documentation:
- Paper claim scanning requires the user to select the appropriate batch class from a listing of >50 batch classes, which determines the claim load into the correct business unit or work queue within the claims processing system
- Digitizing all corresponding radiographs / photos and orthodontic models received simultaneously with paper claims to assure complete and diagnostic images are available to assure proper determinations.
- Team members must have the ability to make sound independent decisions that drive adjudication accuracy.
- Additional support is dedicated daily to the digitizing of documentation received for multiple departments :
- Complaints, Grievances & Appeals – includes a process for specific handling of radiographs or photos
- Provider Credentialing and Enrollment – daily mail which includes provider contracts, W9’s and change of address information
- Utilization Review – Case files are digitized to minimize the retention of paper files
- Vision/ eyeQuest – Paper claims are digitized, eliminating the need to manual entry
- Processing of claims identified as Urgent or Special Handling which require immediate attention to address the member’s needed services timely.
- Accept and log AM and PM deliveries from USPS and multiple other couriers throughout each business day. Daily average of 13,000 pieces per day with high volume days exceeding 20,000 pieces of mail.
- Responsible for managing the document retention policy for paper claims, radiographs and study models as well as the timely and appropriate recycling of those items.
- Support developed accuracy standards and metrics and maintain all required logs for daily production reporting.
- Ensure Protect Health Information (PHI) is secure when handling and processing documents.
- Maintain safe and clean working environment by complying with procedures, rules and regulations.
- Provide recommendations for process improvements within the department and/or enterprise.
- Other duties as assigned.
- High School diploma or equivalent required
- 2+ years office work experience preferred
- Ability to prioritize and organize multiple tasks.
- Ability to work independently and with a team.
- Ability to remain organized with multiple interruptions in a fast paced environment.
- Proficient in basic Outlook, Excel and Word programs
- Demonstrated evidence of effective written and verbal communication skills.
- Ability to work overtime as needed or required.
- Frequent exposure to scanner inks and hardware cleaning supplies.
- Requires the effective use of office equipment including, but not limited to computers, printers and scanners.
- Ability to lift up to 50 pounds is occasionally required.
- Ability to handle repetitive work.
- Ability to remain seated for extended periods to complete tasks
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. **
DentaQuest’s Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.
Community / Marketing Title:
Intake Digital Service
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Milwaukee, Wisconsin US
Equal Employment Opportunity Statement:
DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation.