Dental Claims Specialist
3 weeks ago
Job Title: Associate Business Process Services – Correspondence Specialist
Location: Roseville, CA (Hybrid will be 2 days in office, location is it Roseville CA as long as they can make it in 2 days a week to Roseville.)
Duration: 03 months with possible of extension
Professional Summary:
• This position is responsible for but is not limited to, researching, and analyzing incoming Member Complaints, Member Reimbursement requests, Billing and Enrollment inquiries, miscellaneous member correspondences, etc.
• Determining appropriate paths to follow, creating supporting documentation, processing claims/TARs on final determinations, and extensive communication with members, providers, and additional internal and external customers.
Your role in our mission:
• Research member appeals and grievances and obtain additional information, if needed
• Analyses documents and determine how to proceed to provide a reevaluation.
• Creates documentation supporting the determination and forwards information to consultants as needed.
• Processes claims and TARs based on the final determination from Complaints.
• Regular updating, tracking, and monitoring of extensive caseload in the CRM system.
• Regular communication with both internal and external customers to ensure the appeals and reimbursement claims are concluded successfully and accurately.
• Handles miscellaneous Member Correspondence and requests.
• Adhere to all required service-level agreements.
• Provide support for all provider correspondence functions when needed.
What we're looking for:
• Medi-Cal Dental Program experience needed. Claim/TAR processing preferred.
• Knowledge of Medi-Cal Dental policies, TARs/claims, eligibility, etc.
• A minimum of 1-2 years of related work experience.
• Graduation from an accredited dental assistant school or dental office experience preferred.
• Dental x-ray license needed. Must be able to fluently read dental radiographs.
• Strong organizational, analytical, and critical thinking skills are essential.
• Exceptional attention to detail.
• Excellent customer service skills; fluency in communicating dental terminology.
• Ability to maintain confidentiality, follow up on commitments on a timely basis, and adhere to strict deadlines.
• Strong team player a must.
• Formal writing skills are required. Knowledge and application of English grammar including composition, editing, and proofreading skills.
• Proficiency in MS Office Skills (Outlook, Word, Excel) and Adobe Acrobat required.
What you should expect in this role
• Must be a resident of the state of California.
• Possible Hybrid work environment 1-2 days a week in the office as needed for face-to-face and client meetings with the remainder of the time remote work once needed training is complete.
• Hybrid work will be determined based on adaptability and self-motivation on a case-by-case basis and will be at the discretion of the supervisor.
• The office is in the Roseville/ Sacramento area.
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