Vision Operations Claims Authorizations and Benefits Specialist

Location: Milwaukee, Wisconsin, United States

Notice

This position is no longer open.

Remote Opportunity: 0

Requisition Number: 3858

Position Title: Vision Claims Processor

External Description:

The Vision Claims Processor is responsible for processing and paying claims.  This position is also responsible for processing of prior-authorizations. This position is critical to ensuring that all claims payment and prior-authorization processing requirements for all our programs under the direction of the Vision Supervisor.

PRIMARY JOB RESPONSIBILITIES:

  • Process and pay claims accurately in a timely manner per contractual and regulatory requirements.
  • Process prior authorization requests accurately in a timely manner per program requirements.
  • Process all requests for adjustments internal and external.
  • Work with providers to gather missing information for claims and prior-authorizations.
  • Resolve any claims and prior-authorization issues.
  • Resolve claims and prior-authorization related tickets received from customer service calls.
  • Resolve claims and prior-authorization related tickets received from the portal.
  • Process org determination requests received from customer service calls.
  • Create and deliver client specific invoices for billing.
  • Validate member eligibility is updated in a timely manner and work with Client Data Management and systems vendors to address issues.
  • Send accurate and timely claims and prior-authorization correspondence to members and providers.
  • Report system issues to systems vendor partners and collaborate on resolution.
  • Provide subject matter expertise for process improvements, documentation and systems testing.
  • Other duties as needed or required.

 

JOB QUALIFICATIONS: 

Required:

  • High school diploma or equivalent.
  • Well-organized and superior organizational, written and oral communication skills, particularly presentation skills.
  • Attention to detail, accuracy and organization skills are essential.
  • Ability to remain organized with multiple interruptions.
  • Ability to work independently and as part of a team.
  • Proficient with general computer software including Microsoft Excel, Word and Outlook.
  • Proven problem-solving skills.
  • Ability to make good judgment conclusions based on data available with minimal supervision.
  • Ability to prioritize and organize multiple tasks with tight deadlines.

Preferred: 

  • Bachelor’s degree in business or healthcare field, or equivalent experience in healthcare management.
  • Knowledge of benefits and insurance.
  • 2 years claims payment & customer service experience.
  • Knowledge of provider payment methodologies.
  • Experience with CPT and ICD Coding.
  • General knowledge of vision and eye care.
  • Strong math competency. 

PHYSICAL DEMANDS: 

  • Ability to work in a traditional professional office setting or remote equivalent.
  • Ability to effectively operate computer equipment.
  • Work schedule may vary and is determined by project schedules.
  • Ability to travel as projects dictate.
  • Ability to efficiently operate all job-related office equipment.
  • Ability to communicate via telephone and work in virtual teams.
  • Ability to work in a dynamic environment.
  • Ability to sit for more than 90% of an 8 hour day.

 

City: Milwaukee

State: Wisconsin

Community / Marketing Title: Vision Operations Claims Authorizations and Benefits Specialist

Company Profile:

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.

Company Profile Job:

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.

Location_formattedLocationLong: Milwaukee, Wisconsin US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our 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. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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