Dental Claims Representative

DENTAL CLAIMS REPRESENTATIVECOME GROW WITH US! Are you tired of working late nights and weekends? Join the Healthplex team and apply your dental experience in our beautiful new corporate office located in the Omni building.About HealthplexHealthplex is known as "The Dental Plan Specialists." The company was established in the 1970's by dentists and other healthcare professionals who were concerned about the increasing costs of dental care. With an understanding of dentistry and dental insurance, Healthplex offers benefit plans that effectively manage the risks associated with conventional indemnity plans. Two million subscribers later, the corporation is providing dental benefits and administrative services for insurance companies, HMOs, school districts, municipalities, welfare funds and businesses of all sizes.
In New York, dental plans are underwritten by Dentcare Delivery Systems, Inc., a not-for-profit Health Services Corporation, Healthplex Insurance Company, the United States Life Insurance Company and other licensed organizations. In New Jersey, benefits are available through our wholly owned Dental Plan Organization, International Healthcare Services, Inc. In addition to dental benefits and administrative plans, Healthplex maintains one of the largest Preferred Provider Organizations in the Northeast. The company is also certified as a Credentials Verification Organization in eleven out of eleven credentialing elements by the National Committee for Quality Assurance. The National Committee for Quality Assurance is an independent, non-profit organization that certifies credentials verification organizations and accredits managed care organizations.
Visit our website at www.healthplex.com

SUMMARY:A Dental Claims Processor adjudicates dental claims for payment based on summary plan descriptions.

ESSENTIAL DUTIES AND RESPONSIBILITIES:Include the following. Other functions may be assigned as business conditions change.
Sort, count and record daily mail into groups and separate claims to be reviewed by dental consultant (x-rays).
Adjudicate claims for payment according to group guidelines. Review member history, eligibility, student status, coordination of benefits, fee schedules, member address, doctor address and other information to verify correctness.
Ensure adjudication of claims meets department turnaround time framesReview and process electronic claims.
Confer with dental consultants regarding high priority cases and/or unclear treatment plans.
Enter coordination of benefits information.
Handle claim adjustments taken by CustomerAssist group representatives with questions regarding eligibility, claim issues and plan guidelinesResearch to find correct address when EOB's and checks are returned. When applicable, make corrections and resend.
Return claims to provider/member when essential information has been omitted from the claim form.
Make sure claim numbers and member name/identification numbers are written on all attachments to claim and given to the imaging department on a daily basis.
Complete refund request forms and type refund request letters regarding overpayments made to members and/or providers.
Act as a back up (sorting and processing precerts and claims) for other representatives to cover absences or vacations REQUIREMENTS
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 ExperienceOne year certificate from college or technical school; or one year minimum related experience and/or training; or equivalent combination of education and experience. Dental office experience strongly preferred.
COMPUTER SKILLS:
Knowledge of Database software, strong alpha-numeric data entry skills.
OTHER SKILLS:
Knowledge of ADA codes, dental procedures and terminology. Strong attention to detail.
Healthplex offers excellent compensation and working conditions. Employee benefits at Healthplex, Inc include:Generous paid time offMedical Insurance Free dental coverage401K Plan with employer contributionsGroup term life insurance

Send your resume and salary requirements to Attn: HR fax/e-mail (516)228-1744,

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