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Dental Claims Team Lead at Avesis

Posted in General Business 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Phoenix, Arizona

Job Description:

About the Organization Avesis has been providing essential ancillary benefit solutions since 1978. Since its inception Avesis has developed, administered and refined its offerings to provide clients with best-in-class product choices and services. Today, our programs cover more than 8.5 million members throughout the country. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus.

The continued upward spiral in health care costs has challenged sponsors, providers and payers of health benefits to deliver high quality care in the most cost-effective manner possible. The Avesis benefits menu has been created to meet that challenge by making available quality essential ancillary benefit services at the lowest possible price while never sacrificing the highest quality of service. Providing outstanding customer service is a top priority, and our core values of accountability, empowerment, excellence, and integrity help us achieve high member and client satisfaction.

As of January 2016 Avesis is a wholly-owned, independent subsidiary of The Guardian Life Insurance Company, a distinction that brings even more capabilities to Avesis. The Guardian is a Fortune 250 mutual insurance company that has put its policyholders and clients above all else for more than 150 years, and it has earned them not only a great reputation but awards and accolades from such authorities as J.D. Power. Adhering to high standards, doing the right thing, and making people count are the founding principles that has kept Guardian financially sound and made them one of the largest insurance companies in the country.

In January 2017, Premier Access joined the Avesis family. Premier Access has focused on direct state contracts for Medicaid and Chip, specifically in California and Utah. They were one of the original participants in the Chip and Medicaid programs. Description Position Overview
This position is located in the Claims Department of Avesis' operations center in Phoenix, Arizona. The Claims Team Lead assists the Supervisor and Claims Manager with daily operations. Monitors and assists a designated group of claims processors and provides first line technical contact for any claims related issues associated with Vision, Dental and Hearing claims. Responsible for coordinating work-flow, leading efforts in error reduction, and support of team members with claim payment procedures. Provide general instruction related to claim adjudication. Applies the policies and procedures as required for complex benefit issues. Provides feedback to the supervisor, regarding claims issues, process improvement opportunities and any areas of concern. Demonstrates leadership ability by encouraging positive behavior and improving efficiency.

Essential Job Functions

  • Demonstrate knowledge and understand Avesis' contracts and performance requirements, claims processing work flow, and payment process.

  • Assist Supervisor in resolving aged claims or handling of claims adjustment projects.

  • Provide technical assistance to claims department staff.

  • Process and evaluate difficult or non-routine claims to ensure accurate handling.

  • Enter claim data accurately and timely and adjudicate claims submitted via electronic submission.

  • Thorough knowledge of diagnostic and procedural coding for Vision and/or Dental claims.

  • Skilled use of Avesis systems and applications for claims adjudication and research of provider, member, and utilization management data.

  • Timely and accurate processing of Vision and/or Dental claims as required in contractual and regulated time frames.

  • Testing of system modifications to ensure accurate processing and outcome.

  • Apply policies and procedures to confirm that claims meet the criteria for payment as indicated in contractual guidelines.

  • Presenting topics and attendance in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.

  • Monitor claims inventory and make recommendations for improving outcomes.

  • Ability to meet or exceed quality, accuracy, and production standards as determined by Avesis.

  • Minimum 2 years prior claims processing experience required

  • Associates degree in a related field is preferred; High School Diploma or GED is required

  • Knowledge of Medicare, Medicaid, and Commercial insurance

  • HCPCS, CPT, CDT and ICD 10 coding

  • Strong skills using Microsoft applications and other windows-based tools

  • Exhibit strong skills for reading, writing, and communicating at a professional level

  • Proficiency in managing multiple tasks and prioritizing work

  • Ability to supervise and lead others

  • Ability to think analytically and make independent decisions

  • Ability to handle multiple and changing priorities

  • Capable of maintaining positive working relationships

  • Effective time management and organizational skills

  • Ability to work overtime as needed

Position Requirements

  • 3 years' experience in in processing applicable type claims
  • Associate's degree in a related field preferred; High School diploma required
  • Knowledge of Medicare, commercial and Medicaid insurance and CPT and ICD-9/10 codes
  • Excellent written and verbal communication skills
  • Strong skills in using Microsoft Office applications and other windows-based applications

Category Claims Full-Time/Part-Time Full-Time Exempt/Non-Exempt Non-Exempt EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. This position is currently accepting applications.