Position Title:

Accounting Assistant II - Accounts Receivable Division

Reports To:

Senior Accounts Receivable Representative

FLSA Status:

Non-Exempt

Summary:

Intricately involved with the collection, depositing and recording of all forms of cash related transactions. Performs various other functions in support of the Accounting Department when needed.

Essential Duties and Responsibilities:

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

Downloads lockbox transactions from Citibank and prepares the required data entry to internal systems.

Processes CDM (Client Decision Module) Lockbox transactions as required.

Enters all incoming wires and ACH Transactions ? premium, check run ASO and SI.

Accesses direct debit and credit card transactions, updates spreadsheet and uses dataport to enter data into internal systems.

Processes refund adjustments and bounced ACH transactions when required.

Processes manual credit card payments and refunds over the phone for groups/members.

Scans checks received in the office into Citibank and makes data entry into internal systems.

Processes daily website enrollments.

Sends daily cash receipts to MIS and Billing Departments.

Imports new group information into Navision using dataport.

Completes monthly application of groups for each company. (Credits, etc.).

Respond to communications from groups/members concerning credit card and web payments.

Compile the declined and expired credit card list and creates mailing notification.

Reconciles petty cash.

Assist Senior Accounts Receivable Representative with various tasks when requested.

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:

Two or four year degree in Accounting or related field from an accredited college or university, and two years? experience in an accounting environment or related area and/or training; or equivalent combination of education and experience.

Computer Skills:

Proficiency in Navision, Oracle and Microsoft programs ? Word, Excel, and Outlook.

Other Skills:

Detail oriented with strong data entry skills. Familiar with standard accounting concepts, practices and procedures as well as general banking processes

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Position Title:

Bilingual Customer Service Representative

Reports To:

Director of Customer Service

FLSA Status:

Full Time

Summary:

A Bilingual Customer Service Representative must be able to speak/read/write in English as well as one of the following: Spanish, Russian, Mandarin, or Cantonese. A Bilingual Customer Service Representative assists our members in an inbound call center by investigating and responding to all member inquiries regarding dental plan coverage, status of claims, provider information, and any other information that will assist our members. Customer Service Representatives are full time employees scheduled for 35 hours a week. We are currently looking to fill positions for Monday-Friday from 10:30am to 6:00pm. Paid training will be the first seven business days of employment from 9:00am to 4:30pm.

Essential Duties and Responsibilities:

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

Efficiently answer inbound calls while resolving member issues concerning their dental coverage

Handle irate customers in a professional manner

Adhere to all attendance/punctuality policies and procedures

Absorb and retain information to ensure consistency when explaining benefits, regulatory items, and policy and procedures

Meet or exceed standards of quality and professionalism as set by both Healthplex and the NCQA

Provide professional and courteous service to all lines of business

Ensure consistency and adherence to departmental work flows, policy and procedures

Follow appropriate avenues of protocol to elevate 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

Obtain customer feedback information and multi task while on the phone

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. Preferred Experience: 1 year of Customer Service Call Center experience. Experience working in Dental Office and/or HMO/Insurance

Computer Skills:

Basic computer skills as well as quick and accurate typing skills.

Other Skills:

Fluent (speak/read/write) in English as well as Spanish, Russian, Mandarin, or Cantonese. Excellent communication skills (good grammer, voice, and diction). Excellent customer service skills (friendly, courteous, and helpful).

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Position Title:

Clinical Reviewer (Licensed Dentist)

Reports To:

Director of Utilization Management

FLSA Status:

Non-Exempt, Part-Time

Summary:

The primary function of the Clinical Reviewer is to review dental claim forms, treatment plans and other documents relating to the provision of dental services and impose, wherever applicable, the exclusions and 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:

All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

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Position Title:

Credentialing Assistant

Reports To:

Director of Credentialing - Healthplex, Inc.

FLSA Status:

Non-Exempt, Non-Union

Summary:

A Credentialing Assistant processes provider information as directed and provides general administrative support to the Credentialing department.

Essential Duties and Responsibilities:

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

Performs application data entry with strong attention to detail.

Handles follow-up phone calls to providers.

Primary source verification for state licenses, DEA certificates, malpractice insurance and sanctions

Mailing of provider applications.

Filing and scanning of provider 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 skills. Familiarity with a keyboard. Excellent verbal communication skills and phone etiquette.

Other Skills:

All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

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Position Title:

Data Entry Processor

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. All qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.

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