Position Title:

Data Entry Technician

Reports To:

Claims Manager

FLSA Status:

Union; Non-Exempt; Full-Time

Summary:

A Data Entry Technician in the Claims Department is responsible for accurately entering data from claim forms.

Essential Duties and Responsibilities:

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

Accurately enter high volume of dental claims data into company database.

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:

Strong Data Entry Skills. Minimum data entry speed of 10,000 + keystrokes per hour required.

Other Skills:

Punctual, reliable, strong attention to detail skills required.

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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:

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:

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. 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).

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Position Title:

Dental Consultant

Reports To:

Dental Consultant

FLSA Status:

Non-Exempt

Summary:

The primary function of the Dental Consultant is to review dental claim forms, treatment plans and other documents relating to the provision of dental services and impose, wherever applicable, the exclusions & limitations of the Companys dental benefit plans.

Essential Duties and Responsibilities:

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

Review documents submitted by managed care and fee-for-service dentists in the manner set forth in the Companys policies.

Respond on a timely basis to inquiries from staff members regarding the provision of services to enrollees.

If requested, to participate as a member of the Quality Improvement Committee.

If requested, to participate as a member of the Utilization Review Committee.

If requested, to participate as a member of the Complaint and Appeals Review Committee.

Qualifications:

Licensed as a dentist under the laws of the State of New York, authorized to practice dentistry and currently approved by the Department of Education of the State of New York

or;

Licensed as a dentist under the laws of the State of New Jersey, authorized to practice dentistry and currently approved by the Department of Law & Public Safety, Division of Consumer Affairs of the State of New Jersey.

Have no history of any Medicaid/Medicare and/or other governmental regulatory sanctions.

Be properly credentialed by a Credentials Verification Organization.

Maintain a knowledge of current dental procedures, terminology and treatment codes.

Education And/Or Experience:

Be a graduate of an accredited dental school.

Have a minimum of ten (10) years experience in the dental field.

Computer Skills:

Other Skills:

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Position Title:

Report Analyst

Reports To:

Director, Reporting Services

FLSA Status:

Exempt

Summary:

A Report Analyst determines report requirements, identifies target data, builds/maintains appropriate data model, establishes/maintains data transformations, creates/modifies required queries, creates/modifies report presentation, verifies report accuracy, delivers the finished report, documents report process and maintains the reporting schedule.

Essential Duties and Responsibilities:

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

Utilizes the Ingenix tool suite to create: provider directories, Geo Access reports and disruption reports

Designs, develops and supports ad hoc reports using reporting tools

Analyzes and develops Oracle PL/SQL to retrieve the appropriate data when necessary

Interfaces with customers through the life cycle of the report request

Documents report fabrication procedures for quality assurance

Revises report queries for optimal performance

Implements safeguards to validate accuracy of report results

Recommends establishment of new or modified reporting methods and procedures to improve report content and completeness of 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:

4-year degree in Computer Science from College or University or equivalent related experience.

Computer Skills:

Ingenix and GeoAccess/GeoNetwork, Oracle PL/SQL, ETL, Data Modeling, Data Warehouse/Data Mart, Microsoft Access, Excel. OBIEE a strong plus.

Other Skills:

Highly motivated and seeks out opportunities to improve existing processes. Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Superior organizational skills, attention to detail, and ability to prioritize and manage multiple tasks. Knowledge of dental billing/claims, managed health care, health insurance claims a strong plus.

Apply Now

Position Title:

Provider Relations Representative

Reports To:

Provider Relations Manager

FLSA Status:

Non-Exempt

Summary:

A Provider Relations Representative performs all responsibilities relating to provider issues as outlined below.

Essential Duties and Responsibilities:

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

Build and maintain dental provider panels by initiating and maintaining effective channels of communication with participating and prospective providers

Recruit providers as needed

Handle provider contracting and assist in negotiating fees

Communicate with panel doctors regarding plan changes and other issues

Validate and authorize all changes to the Oracle Provider Database by accurately completing top sheets

Respond to provider questions regarding participation, plans, fees and special requests

Interface with multiple departments (e.g. Claims, Customer Service, Credentialing Marketing) to research and resolve provider issues or to assist with special projects such as recruitment to support member growth

Reduce risk through quality assurance program

Develop and maintain directory data for all Locals and PPO groups

Periodically visit provider offices to orient office staff in policies, fee schedules and claims processing

Work as part of the Provider Relations Team in producing accurate Provider Directories, updating internal documents, reviewing mailing lists for accuracy, coordinating and attending sanctioned events, and promoting corporate and departmental initiatives

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 of Science Degree (B.S.) plus 2-4 years experience or equivalent combination of education and experience in the dental healthcare industry.

Computer Skills:

Knowledge of Outlook Contact Management systems. Proficiency in Microsoft Software programs – Word, Excel, Access, Outlook. Ability to learn and successfully navigate proprietary programs.

Other Skills:

Ability to work as part of a team, communicate effectively with a variety of audiences, support a vision and direction, and to work independently within deadlines. Knowledge of dental procedures and terminology. Maintain a high level of professionalism and demonstrate sound judgment. Demonstrate the ability to successfully juggle a heavy and varied workload.

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Position Title:

Outreach Representative - PT (June 1st - December 15th)

Reports To:

Clinical Quality Administrator

FLSA Status:

Non-Exempt

Summary:

An Outreach Representative in the Government Services department works directly with members and provider offices to increase utilization and access / availability of services to members.

Essential Duties and Responsibilities:

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

Reach out to members by phone and encourage them to utilize their coverage

Educate members on their dental benefits and provide members with assistance scheduling an appointment with a Healthplex dental office

Track and document member calls

Reach out to provider offices to provide education on increasing office visits of Healthplex members

Track and document provider calls

Work with provider offices and members in need of dental appointments to get appointments scheduled.

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 with (1-2) years of Customer Service Call Center experience preferred. Excellent verbal and written communication skills. Bilingual Spanish and Cantonese a plus.

Computer Skills:

Basic computer and keyboarding skills.

Other Skills:

Dental and/or Health insurance knowledge not required, but preferred. Excellent communication skills. Good grammar, voice and diction. Excellent customer service skills (friendly, courteous and helpful)

Apply Now

Position Title:

Project Coordinator/ Dental Group Administrator

Reports To:

Chief Financial Officer, Healthplex, Inc.

FLSA Status:

Non-Exempt

Summary:

A Project Coordinator/Dental Group Administrator will facilitate commercial group implementation, working with internal departments and customers of Healthplex administered dental plans.

Essential Duties and Responsibilities:

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

Assist with the creation and distribution of new group and/or plan revision implementation spreadsheets.

Monitor progress of new group implementation and/or revisions to existing groups.

Liaison and follow up with other departments to ensure tasks relating to group implementation and enrollment are completed

Conduct interim follow up/status report meetings as needed.

Document Enrollment department policies and procedures and periodically review for accuracy

Perform all aspects of Oracle database administration concerning small group set up, maintenance of provider data, group notes and other functions as directed

Ensure integrity of documents for Commercial business (ie: proof brochures, letters, fee schedules)

Assist with monthly Enrollment department audits

Assist with group inquiries

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 two + years’ related experience and/or training or equivalent combination of education and experience.

Computer Skills:

Microsoft Project, Outlook, Excel, Word and Publisher, ability to type at least 55 wpm. Familiar with Oracle database systems a plus.

Other Skills:

Apply Now