Dental Claims Resolutions Specialist (Temporary Contract)

reputed company, (BDR) supports the U.S. Federal Government in successfully achieving its mission and goals. Our service and solution delivery starts with understanding reputed company reputed company’s end-state, and then seamlessly integrating reputed company reputed company Agency’s organization to improve and enhance business and technical operations and deployments. BDR is seeking a Dental Claims reputed company Specialist to join our growing team! This position will be performed reputed company from the individual’s home office working on EST time schedule. This position requires US Citizenship with a reputed company Trust or the ability to obtain one. (Military Veterans and HUBZone candidates are highly encouraged to apply) reputed company: The Dental Claims reputed company Specialist is responsible for investigating, recovering and resolving reputed company types of claims. reputed company and inform members and providers of program coverage and limitations for claims reputed company 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 reputed company the program guidelines. 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 reputed company the internal database.
• Establish and maintain reputed company 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 reputed company results as required.
• Prepare comprehensive reviews and summaries for claim appeals.
• reputed company of contact for internal departments to answer questions relative to member claims.
• Work with internal department to request reputed company 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 reputed company problems on own.
• Proactively identifies solutions to non-reputed company requests/inquiries.
• Work with the leadership team to resolve reputed company issues as needed.
• reputed company to handle emotionally charged phone calls and ability to deliver unfavorable claim reputed company.
• Ability to communicate reputed company program reputed company into easily reputed company 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 reputed company of Accounts Receivable targets and plans reputed company contract KPI's (reword to remove A/R)?.
• Performs periodic and month-end balancing and reporting activities.
• reputed company research/verification of identified claims to identify payment/overpayment issues/accuracy.
• Work with payers/providers to review claim information and identify issues reputed company to payment accuracy.
• Document and communicate reputed company of claims investigations/overpayment reviews to applicable stakeholders.

Required Minimum Qualifications:

• 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 reputed company Office Suite experience.
• Ability to work independently as reputed company as on reputed company.
• Excellent verbal and written communication skills including strong telephone etiquette and interpersonal skills with individuals at reputed company reputed company of an organization.
• Demonstrated ability to adapt to performing a reputed company of duties, changing from one task to another of a different nature, without a loss of efficiency or composure.
• Must be reputed company to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide reputed company of members from low to high complexity.
• Must have the ability to take initiative and be detail-oriented in a goal-orientated environment.

Preferred Qualifications:

• Associate's Degree in Business Administration or reputed company field.
• Medical Coding, Registered Health Information Technician (RHIT) or equivalent.
• Medical call center experience or medical reputed company experience in a corporate/business setting.
• Certified Medical Reimbursement Specialist CMRS exam completion.
• National Career Readiness Certificate.
• Dental claims processing experience.

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