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The Resolution Claims Processor is responsible for processing dental claims/referrals received from providers and health plan members in accordance with policies, procedures, and guidelines as outlined in Avesis contractual agreements. Claims are processed using Avesis systems and on-line reference resources that specify the details and scope of benefits. The processors’ productive output is guided by performance objectives that specify the volume of claims to be processed on an hourly basis. The Claims/Referral Processor must be able to meet accuracy, quality, and productivity standards as determined by Avesis.
Essential Job Functions:
- Understand Avesis’ contracts and performance requirements, claims processing workflow and payment process.
- Resolving escalated claims through research, tracking and trending of issues to improve internal processes by voids, refunds and recoupment.
- Works independently on special projects assigned by Leadership and/or Executive Team
- Comprehensive knowledge of diagnostic and procedural coding for dental terminology.
- Utilizes resources and critical thinking to analyze complex claims scenarios in an efficient manner, adjust and correct accordingly.
- Apply policies and procedures to confirm that claims meet the criteria for payment as indicated in contractual guidelines.
- Attend and participate in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.
- Ability to meet or exceed quality, accuracy, and production standards as determined by Avesis.
- Respond to inquiries from any Avesis team about claims/referral in a 48hr time period
- Other duties as assigned.
Requirements:
- High School Diploma or GED is required; Associates degree in a related field is preferred
- Dental background (preferred)
- Prior claims processing experience
- Knowledge of Medicare, Medicaid, and Commercial insurance preferred
- HCPCS, CPT, CDT & ICD 10 coding
- Strong skills using Microsoft applications (Adobe, Word, Excel, Etc.) and other windows-based tools
- Excellent written and verbal communication skills
- Ability to manage multiple tasks and prioritize work
- Effective time management and organizational skills
- Ability to work overtime as needed
FLSA Status: Hourly/Non-Exempt
Salary Range Hourly Rate: $12.51 - $19.59
How to stay safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.
We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.
To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!
