Digital Service Rep I
Location: Milwaukee, Wisconsin US
Job Number: 1318
The Digital Services Representative I is responsible for a significant variety of critical functions necessary to support day-to-day claims intake operations. This position is responsible for ensuring DentaQuest meets all guidelines and turnaround times set by state and federal regulations and/or plan contracts specific to Intake
Primary Job Responsibilities
- Accountable for robust understanding of Delta, Commercial, Vision as well as State & Health Plan business clients, client requirements, claim & UM policies, and procedures that relate to Intake
- Accept, sort and log mail deliveries from USPS, FedEx and other couriers
- Open and sort incoming mail accurately into appropriate categories for further mail preparation
- Prepare paper claims, authorizations, and x-rays by ensuring correct procedures are followed
- Accurately identify specific document types and ensure they are appropriately identified and organized
- Basic document scanning for business docs such as Cred, Appeals & Fraud
- Evaluate prepared mail and accurately assign barcode identification labels for document image scanning for x-rays and ortho model claims
- Digitize all x-rays received simultaneously with paper claims to assure complete and diagnostic images are available to guarantee proper determinations
- Digitize ortho models using ShapeGrabber software
- Responsible for adhering to the document retention policy for paper claims, x-rays, and ortho models as well as the timely and appropriate recycling of those items
- Prepare provider returns for missing and incomplete documents
- Support developed accuracy standards and metrics and maintain all required logs for daily production reporting
- Ensure Protected Health Information (PHI) is secure when handling and processing documents
- Maintain safe and clean working environment by complying with procedures, rules, and regulations
- Participate in peer to peer training as requested to assist new team members and/or increase personal knowledge of functions
- Adhere to business processes
- Performs other duties as assigned
- High School Diploma or equivalent
- 2+ years of office work experience
- Strong attention to detail and high degree of accuracy
- Excellent interpersonal skills
- Acceptable written and oral communication skills
- Knowledge of general computer software
- Ability to prioritize and organize multiple tasks
- Ability to work in excess of 40 hours in a week when necessary, as needed or required to meet business needs
- Interacts in a cooperative, professional, and effective manner with all internal and external personnel
- Ability to handle repetitive work
- Incumbent must be able to communicate effectively.
- Requires overall light physical effort (up to 25lbs.)
- Manual dexterity and sitting are required in carrying out own position responsibilities (i.e. use of personal computer).
- Ability to efficiently operate all job-related office equipment such as scanners, printers and digitizers
- Ability to travel or move about within and outside serviced facilities required.
Webelieve 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 deliveringmeasurableoutcomes 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.
Job Number: 4143
Community / Marketing Title: Digital Service Rep I
Location_formattedLocationLong: Milwaukee, Wisconsin US