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SalaryWhy Join Sierra7?
Sierra7 is a Small Disabled Veteran Owned Business. We were founded in 2009 with the mission of "Serving those who Serve". We recently received the DAV (Disabled American Veteran) award. Also, Sierra7 is ranked No. 457 out of 5,000 fastest growing private companies in America by Inc. Apply today and help us with our mission of "Serving those who Serve".
Benefits:
- 401K
- Medical/Dental/Vision
- Pet Insurance
- LinkedIn Learning
About this role:
The Dental Claims Resolution Specialist is responsible for investigating, recovering and resolving all types of claims. Educate and inform members and providers of program coverage and limitations for claims within contract requirements. Use critical thinking, research and problem-solving skills to navigate through the complexities of a member's health benefits and their respective claims while remaining within the program guidelines.
Salary: $17.20 an hour plus $4.22 Health and Welfare
Primary Responsibilities:
- Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members/health care providers while keeping a detailed record within the internal database
- Establish and maintain positive relationships with members, providers and our claims contractor
- Demonstrates great depth of knowledge/skills in own function
- Request and manage medical records to help determine potential program coverage and communicate results to the members
- Completion of system generated tasks, including documenting all results as required
- Prepare comprehensive reviews and summaries for claim appeals
- Point of contact for internal departments to answer questions relative to member claims
- Work with internal department to request code additions or other avenues to resolve issues in the program where appropriate
- Understand the claim lifecycle and ensure that claims are resolved through the entire process
- Solves moderately complex problems on own
- Proactively identifies solutions to non-standard requests/inquiries
- Work with the leadership team to resolve complex issues as needed
- Able to handle emotionally charged phone calls and ability to deliver unfavorable claim outcomes
- Ability to communicate complex program criteria into easily understood summaries in both oral and written communication
- Validation of claim coverage in relation to program guidelines
- Plans, prioritizes, organizes and completes work to meet established objectives and metrics
- Complete activities and reporting as required by the fraud, waste and abuse plan
- Monitor progress of Accounts Receivable targets and plans within contract KPI’s
- Performs periodic and month-end balancing and reporting activities
- Perform research/verification of identified claims to identify payment/overpayment issues/accuracy
- Work with payers/providers to review claim information and identify issues related to payment accuracy
- Document and communicate outcomes of claims investigations/overpayment reviews to applicable stakeholders
- Minimum of three years of claims processing or similar experience
- Equivalent combination of education, experience and/or applicable military experience will be considered
- Proficient computer skills with Microsoft Office Suite experience
- Ability to work independently as well as on a team
- Excellent verbal and written communication skills including strong telephone etiquette and interpersonal skills with individuals at all levels of an organization
- Demonstrated ability to adapt to performing a variety of duties, changing from one task to another of a different nature, without a loss of efficiency or composure
- Must be able to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide range of members from low to high complexity
- Must have the ability to take initiative and be detail-orientated in a goal-orientated environment
- High speed internet (minimum 20+ Mbps download / 5 Mbps upload)
- Must be able to hardwire into internet connection
- Must have a private workspace
Preferred Qualifications:
- Associate’s Degree in Business Administration or related field
- Medical Coding, Registered Health Information Technician (RHIT) or equivalent
- Medical call center experience or medical related experience in a corporate/business setting
- Certified Medical Reimbursement Specialist CMRS exam completion
- National Career Readiness Certificate
- Dental claims processing experience
This posting is for prospective candidates only. Unsolicited third-party resume submissions will be considered property of Sierra7, Inc. and will not be acknowledged or returned.
Disclaimer:
The above salary range represents a general guideline; however, Sierra7 considers a number of factors when determining base salary offers such as the scope and responsibilities of the position and the candidate's experience, education, skills and current market conditions.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Sierra7 will not provide sponsorship for employment-based immigration benefits for this position. To be considered for this position all candidates must be a US Citizen. This position is not a C2C opportunity.
Sierra7 is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.
Equal Opportunity Employer Veterans Disabled
