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product support Remote

Avesis

Full Time Remote 10.56 - 12.04 USD Today

Job description

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

The Referral Specialist is responsible for processing dental referrals and/or claims received from providers and health plan members in accordance with policies, procedures, and guidelines as outlined in Avesis contractual agreements. Referrals and 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 referrals and/or claims to be processed on an hourly basis. The 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, referral and claims processing workflow and payment process.
Resolving escalated referrals and claims through research, tracking and trending of issues to improve internal processes by voids, refunds and recoupment.
Comprehensive knowledge of diagnostic and procedural coding for dental terminology.
Utilizes resources and critical thinking to analyze complex referral and claims scenarios in an efficient manner, adjust and correct accordingly.
Apply policies and procedures to confirm that referrals and claims meet the criteria for payment as indicated in contractual guidelines.
Attend and participate in team meetings related to referral and 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.
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

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!

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