Position Title:

Office Assistant

Reports To:

Credentialing Supervisor

Status:

Part Time, Temporary (3-4 hours per day, 3-5 days per week

FLSA Status:

Non-Exempt

Summary

An Office Assistant provides general administrative support and performs essential duties outlined below.

Essential Duties and Responsibilities:

Include the following. Other functions may be assigned as business conditions change.

Scanning and filing documents in support of the Credentialing Department.

Other clerical responsibilities as needed.

Qualifications:

To perform this job successfully, an individual must be able to work under tight timelines, have the ability of manage multiple tasks, be detail oriented and have good inter-personal skills. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED.

Computer Skills:

Basic computer skills. Familiarity with a keyboard.

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Position Title:

Provider Relations Assistant

Reports To:

Director, Provider Relations, Healthplex, Inc.

FLSA Status:

Non-Exempt

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Research provider information for Oracle database updates

Track submitted provider updates in Oracle database

Compile and maintain current managed care provider panel mapping

Collect and distribute weekly managed care provider panel updates to department members

Perform research and information updates for monthly site visit issues

Perform research and information updates for monthly Cactus reports

Perform Access cleanup

Aid in list generation for provider panel recruitment

Handle provider calls for recruitment, information changes, website questions, etc.

Perform data entry as needed

Manage and prepare materials for department daily needs and events, e.g., fee schedules, Provider Manual, etc.

Other duties as assigned

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

Bachelor's degree from four-year college or university; and three to four years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Microsoft Outlook, Excel, Word and Access, Oracle, ability to type at least 55 wpm

Other Skills:

Strong communication skills, including writing and grammar. Background in Healthcare helpful.

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Position Title:

Chart Review/Utilization Auditor

Reports To:

Clinical Quality Administrator

FLSA Status:

Exempt

Summary:

A Utilization Auditor is responsible for the implementation of chart reviews either by themselves or the dental office staff and collection of utilization data from dental provider offices.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Visit dental provider offices on scheduled and unscheduled appointments to view charts in order to obtain member utilization data

Conduct chart audits for Healthplex quality assurance program

Identification of process improvements in the doctor’s office and Healthplex as part of the Healthplex quality assurance program

Report HEDIS chart review findings to the Government Services Department and other chart audit findings to the appropriate departments and staff

Responsible for scheduling of appointments to dental provider offices as well as by determining priorities

Assist with special projects as assigned by the Vice President and Clinical Quality Administrator, such as dental screening activities and community events

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma required, college degree preferred with dental assisting certification or two to three years related experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Basic computer skills, knowledge of Microsoft Outlook, Excel, Word.

Other Skills:

Good organizational skills. Ability to work independently and as part of a team. Previous experience in chart reviews and claims payment. Knowledge of dental/medical insurance and/or office management. Excellent communication skills including strong phone and people skills. Reliable transportation, clean driver’s license and willingness to travel two to three days per week throughout Long Island, Westchester and the five boroughs.

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Position Title:

Claims Representative

Reports To:

Claims Manager

FLSA Status:

Full Time

Summary:

A dental Claims Representative adjudicates dental claims based on summary plan descriptions.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Sort daily mail into groups and separate claims that need to be reviewed by dental consultant (x-rays)

Adjudicate claims according to group guidelines. Review member history, eligibility, student status, coordination of benefits, member address, doctor address and other information to verify correctness.

Maintain departmental productivity and accuracy requirements.

Confer with Team Leads if treatment plan is not clear.

Review electronic claims.

Handle claim adjustments taken by customer service and distributed by Auditors.

Research to find correct address when EOB's and checks are returned. When applicable, make corrections and resend.

Return claims to provider/member when information has been omitted from the claim form.

Make sure claim numbers are written on all attachments to claim and given to the imaging department on a daily basis.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

One year certificate from college or technical school; or three to six months related dental assisting and/or insurance billing experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Knowledge of Database software, strong alpha-numeric data entry skills.

Other Skills:

Knowledge of ADA codes, dental procedures and terminology.

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Position Title:

Assistant Operations Manager

Reports To:

Operations Manager, Customer Service

FLSA Status:

Exempt

Summary:

An Assistant Operations Manager's primary function is to support the Operations Manager in the supervision of call center staff as outlined below.

Essential Duties and Responsibilities:

Include the following. Other functions may be assigned as business conditions change.

Act as a backup to Operations Manager in monitoring multi ACD lines and productivity and Quality of Team Leads and their respective teams.

Supervise staff performance and monitor production and Quality with regards to telephone activity. Report findings back to Operations Manager.

Provide feedback and suggestions on staffing and development to the Operations Manager.

With the assistance of the Operations Manager, develop workflow plans to anticipate trends in the department relating to productivity.

With the assistance of the Operations Manager, document policies and procedures and create workflows.

Support the Operations Manager in writing and administering performance reviews and performance documents for skill improvement.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

4-year degree or higher from college or university plus 5 years related Call Center supervisory experience and/or training; or equivalent combination of education and experience.

Computer Skills:

Strong MS Word, Excel and keyboarding skills. Familiar with Oracle-based database system a strong plus.

Other Skills:

Strong customer focus, leadership and negotiation skills. Excellent written and verbal communication skills. Good grammar, voice and diction. Excellent customer service skills (friendly, courteous and helpful) Accurate record-keeping skills, strong ability to prioritize tasks, strong conflict resolution skills. Ability to motivate and influence others in achieving departmental goals.

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Position Title:

Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full time

Summary:

A dental Customer Service Representative receives, investigates and responds to all customer inquiries regarding dental plan coverage, status of claims and provider information.

Essential Duties and Responsibilities:

This Position Description may change as business conditions change.

Talk with customers by phone concerning dental plan coverage issues.

Input comments regarding customer issue and relative data into the database.

Call customers when necessary to advise on next steps and/or inform of resolution.

Handle irate customers in a professional manner.

Obtain customer feedback information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Knowledge of dental procedures and terminology. Excellent communication skills. Good grammar, voice and diction. Bi-lingual English/Spanish/Russian helpful. Excellent customer service skills (friendly, courteous and helpful).

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Position Title:

Customer Service Representative

Bi-lingual English/Spanish/Russian/Cantonese/Korean

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A dental Customer Service Representative receives, investigates and responds to all customer inquiries regarding dental plan coverage, status of claims and provider information.

Essential Duties and Responsibilities:

Include the following. Position Description may change as business conditions change.

Talk with customers by phone concerning dental plan coverage issues.

Input comments regarding customer issue and relative data into the database.

Call customers when necessary to advise on next steps and/or inform of resolution.

Handle irate customers in a professional manner.

Obtain customer feedback information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

High school diploma or GED.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Knowledge of dental procedures and terminology a strong plus. Excellent communication skills. Good grammar, voice and diction. Bi-lingual English/Spanish/Russian/Cantonese/Korean. Excellent customer service skills (friendly, courteous and helpful).

Apply Now