Position Title:

Administrative Assistant Part-Time

Reports To:

President - Dentcare

FLSA Status:

Non-Exempt

Summary:

An Administrative Assistant provides administrative support to company executives and corporate legal department as assigned.

Essential Duties and Responsibilities:

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

Create and format documents and templates.

Summarizes documents and contracts.

Edit and review documents proficiently.

Ability to meet multiple deadlines, and possess strong decision making and problem solving skills.

Must possess expert level of written and verbal communication skills.

Screen and answers telephone calls and forwards telephone messages to the President.

Perform special projects as assigned by the President, which require proficiency in MS word and Excel, as well as other MS Office Products.

Excellent organization and time management skills.

Prepare documents for New York Health Exchange.

Prepare and maintain Minutes and advertising books for Dentcare Delivery Systems, Inc.

Create Biographical Affidavits for new Board Members.

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 specifically in the healthcare field; or equivalent combination of education and experience.

Computer Skills:

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

Other Skills:

Demonstrated ability to handle multiple projects and details simultaneously in a fast paced client driven environment. Requires self-direction, tact, diplomacy and a clear, courteous and professional manner when dealing with the co-workers and public. Must demonstrate effective verbal communication skills and the ability to work cooperatively with staff and clients.

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Position Title:

Associate, Grievances and Appeals

Reports To:

Director of Operations

FLSA Status:

Non-Exempt

Summary:

A Grievances and Appeals Associate investigates and resolves member complaints, appeals, grievances and fair hearings for Healthplex and client groups. Provide administrative support to Director of Operations.

Essential Duties and Responsibilities:

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

Provide written acknowledgement of all member and provider correspondence as it relates to member complaints, appeals and hearings.

Conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.

Interface with Healthplex internal departments, clients, and network providers to ensure resolution of case issues in a timely manner.

Compose correspondence related to processing of complaint, appeal and fair hearing cases including preparing correspondence to members, providers and clients, faxing and mailing correspondence, copying correspondence and supporting documents and creating a case file.

Enter notes in Oracle and MS Access as they relate to the initial investigation and resolution of the case.

Monitor pending case files and make necessary follow-up calls to internal and external entities to ensure that cases are completed on or before the applicable timeframe.

Document all actions taken in investigation for auditing and reporting purposes.

Prepare cases for review ensuring that all pertinent information (i.e. correspondence, internal and external responses, diagnosis, radiographs, dental chart) have been obtained during investigation as is present as part of the case.

Open and distribute incoming mail daily.

Maintain files, scan and file cases on a weekly basis by client.

Answer incoming calls and assist caller when applicable.

Contact members and clients by telephone in order to investigate and resolve issues.

Other functions and projects may be assigned as business conditions change.

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 specifically in the healthcare field; or equivalent combination of education and experience. Legal or dental background a strong plus.

Computer Skills:

Proficient in Microsoft Office programs and ability to type 55wpm.

Other Skills:

Demonstrate ability to handle multiple projects and details simultaneously. Requires self-direction, tact, diplomacy and a clear, courteous and professional manner when dealing with the co-workers and public. Must demonstrate effective written and verbal communication skills and the ability to work cooperatively with staff and client.

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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

Reports To:

Director of Utilization Management

FLSA Status:

Non-Exempt

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 & 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.

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.

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:

Accredited Dental school graduate. Minimum of 10 years' experience in the dental field.

Computer Skills:

Microsoft Office Word, Excel Outlook.

Other Skills:

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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:

Credentialing Representative

Reports To:

Director of Credentialing

FLSA Status:

Non-Exempt

Summary:

A Credentialing Representative processes provider information to ensure credentials meet NCQA and JCAHO guidelines.

Essential Duties and Responsibilities:

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

Enter provider information from credentialing application into the Cactus database

Contact providers to request any additional or missing information needed to complete application

Run Queries in Cactus to pull providers that require certain documents to be submitted in between credentialing cycles.

Conduct internet searches to verify providers? credentials and compare results with guidelines to ensure provider meets criteria to join panels.

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:

Associate's degree (A. A.) or one to two years? related experience and/or training or equivalent combination of education and experience.

Computer Skills:

Microsoft Outlook, Excel, Word, Internet. Knowledge of Visual Cactus and Crystal Reports helpful.

Other Skills:

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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:

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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Position Title:

Dental Director

Reports To:

Director of Operations

FLSA Status:

Exempt

Summary:

The primary responsibility of the Dental Director is to create and maintain the Healthplex clinical criteria for UM decision-making as well as oversee all functions of the staff of Clinical Reviewers.

Essential Duties and Responsibilities:

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

Maintains the Healthplex Professional Guidelines for Review of Services for Dental Plans which outlines the criteria for rendering a clinical determination including the specific criteria for issuing a denial for a requested service or treatment based on medical necessity.

Analyzes complaints, quality of care concerns, and appeal requests for denied services and renders a determination.

Identifies and participates in investigations of submission patterns, quality of care issues, over utilization, under-utilization and suspected fraud based on clinical judgment. Reports results and recommendations for corrective action and/or quality improvement to the Quality Improvement Committee.

Participates in the implementation and design of the Utilization Management Program.

Participates as a member of the Quality Improvement Committee.

Participates as a member of the Utilization Management Committee.

Maintains responsibility for orientation and training of Clinical Reviewers.

Supervises staff of Clinical Reviewers and ensures consistency in application of all clinical decision-making.

Evaluates staff training methods and re-trains as needed.

Communicates Utilization Management (UM) guidelines, clinical review rationale, and participates in resolution of UM issues with staff, practitioners, and members.

Licensed as a dentist under the laws of the State of New York, authorized to practice dentistry without restriction 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 without restriction and currently approved by the Department of Law & Public Safety, Division of Consumer Affairs of the State of New Jersey.Must have no history of any Medicaid/Medicare and/or other governmental regulatory sanctions.

Must be properly credentialed by a Credentials Verification Organization.

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

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:

Doctorate degree in the field of dentistry from an accredited dental school.Minimum of ten (10) years experience in the dental field.

Computer Skills:

Other Skills:

Proven leadership ability. Excellent verbal and written communication skills. Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals.

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Position Title:

Document Control Supervisor

Reports To:

Marketing Director

FLSA Status:

Exempt

Summary:

The Document Control Supervisor is responsible for organizing and review approval of corporate materials. This position involves knowledge of the company's group benefit plans, company identity guidelines, understanding of the interdependencies of the departments as well as managing time frames for literature review and production.

Essential Duties and Responsibilities:

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

Delegate assignments to staff.

Review work completed by staff.

Assist with the review of company's social media.

Ensure corporate literature reviewed and approved in a timely manner.

Review/proofread document and print materials to ensure accuracy.

Maintain master templates of current literature.

Maintain Standard Operation Procedures (SOP) for the review/approval process for all corporate literature.

Review commercial and government Provider Directories for panel accuracy and format prior to distribution.

Proof group- specific literature to ensure all content/fees match contractual information.

Coordinate with purchasing employees on printed materials.

Review pre-production proofs from printer.

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:

Bachelors' degree from four-year college and/or 1+ years related experience. English majors strongly preferred.

Computer Skills:

Strong proficiency in English grammar. Strong ability to proofread documents and recommend edits/corrections. Proficiency in Oracle, Word, Excel, and Outlook. Experience with InDesign, Illustrator and/or Photoshop preferred.

Other Skills:

Strong attention to detail. Must have ability to work under minimal supervision, be able to multi-task and learn quickly.

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Position Title:

SQL Developer

Reports To:

Technical Lead, Data Warehousing

FLSA Status:

Exempt

Summary:

The Database Developer will be responsible for the design, and development of database objects and procedural code. The developer will create programs to maintain data integrity in the online transaction processing and data warehouse schemas. Additionally, the database developer will be responsible for creating the stored procedures, triggers, constraints and ETL (extraction, transformation and data loading) programs. The position requires extensive hands-on experience developing stored procedures, ETL code and associated code in Oracle Server and Linux environment.

Essential Duties and Responsibilities:

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

Designing databases and ensuring their stability, reliability, and performance.

Design, create, and implement database systems based on the end user's requirements.

Improve application's performances.

Prepare documentations for database applications.

Memory management for database systems.

Develop database schemas, tables and dictionaries.

Ensure the data quality and integrity in databases.

Fix any issues related to database performance and provide corrective measures.

Create complex functions, scripts, stored procedures and triggers to support application development.

Take regular database backup.

Test databases and perform bug fixes.

Provide authentication and authorizations for Database.

Develop best practices for database design and development activities.

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 from College or University plus 3-5 years related experience.

Computer Skills:

Oracle PL/SQL, Data Modeling, ETL, Data Warehousing, OBIEE.

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 required. Knowledge of dental billing/claims, managed health care and health insurance claims a strong plus.

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Position Title:

Web Application Developer- Entry Level

Reports To:

Manager of Application Development

FLSA Status:

Exempt

Summary:

A Web Application Developer designs critical components of internal and external web applications to achieve project goals and deliverables. Individual must be extremely well-rounded with respect to database, back-end and front end abilities (?full stack?). Duties also include testing, debugging and application support.

Essential Duties and Responsibilities:

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

Designs and writes codes to support existing applications.

Develop strategies for unit and functional testing.

Develops appropriate solutions for system defects and minor enhancements.

Designs/develops/implements forward thinking technical solutions that meet requested need as well as facilitate future enhancements.

Implement vendor supplied applications and design/develop interfaces from internal systems to interact with accordingly.

Provides technical recommendations to help with solving business problems.

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:

Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Be able to perform a variety of tasks. May provide consultation on complex projects and is considered to be the top level contributor/specialist. A wide degree of creativity and latitude is expected.

Computer Skills:

Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Be able to perform a variety of tasks. May provide consultation on complex projects and is considered to be the top level contributor/specialist. A wide degree of creativity and latitude is expected.

Other Skills:

Strong knowledge of Web Applications, J2EE and Java development environments required.Ability to develop UI solutions using current web technologies (using HTML5, CSS and UI frameworks). Oracle 11g/12c with working knowledge of PL/SQL or a major RDBMS. Tomcat, Oracle Application Server or WebLogic Application Server experience preferred. Working knowledge of Open Source Projects (Spring, Pentaho, SVN). Strong communication and interpersonal skills. Highly Motivated/Self-Starter

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