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Associate Business Process Services

3 months ago

Roseville, United States V R Della Infotech Inc Full time
Job DescriptionJob DescriptionDescription:
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

Bill Rate: Bill Rate: BR

Note: All candidates must have valid work authorization in the United States without need for visa-sponsorship.

Note: All candidates submitted on this request will be shortlisted after 48 hours

Professional Summary:
At Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve a community s most vulnerable.
Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare s biggest challenges.
Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills.

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. Dress Code

Additional Details

  • Dress Code : Business Casual
  • Client Interface Required : Yes
  • Overtime Required : No
  • Min Compliance Pay Rate : NA
  • Max Compliance Pay Rate : 1001