DentaQuest

  • Sisters, OR 97759, USA
Jan 22, 2022
DentaQuest Milwaukee, WI, United States
Who We Are:DentaQuest is driven by our mission to improve the oral health of all, to achieve a nation free of dental disease. A nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care. The innovative dental benefits solutions we offer to our clients are delivering better outcomes at lower cost to about 20 million members across the US. The DentaQuest Foundation is working with local, state, and national partners to raise oral health awareness and promote effective oral health solutions.What this Role Does:We are questing for excellent Customer Care Representatives, who recognizes Customer Service as a career choice. If you are passionate about Customer Service, and looking for a growing company, look no further!We are looking for career minded individuals who enjoys providing superior customer service, in a call center environment and who want to make an impact on the...
Jan 22, 2022
DentaQuest Buffalo, NY, USA
JOB SUMMARY: Responsible for managing relationships with Providers within their assigned market. As such, spends most time in the field communicating with providers about suite of benefit programs (Medicaid, Medicare Advantage, Marketplace and Direct to Consumer and Commercial and any blend of dental products), supporting the P&L of the network. Works collaboratively with reporting to understand provider reports and stressing continuous improvement to the Providers (high performance metrics, cost, outliers, quality, etc.) PRIMARY JOB RESPONSIBILITIES: Maintain visibility within their market, with an eye toward managing their book of business across all product lines. Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance. Actively support VBP (Value Based Pay) program. Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
JOB SUMMARY: Perform routine and focused audits electronically to identify inaccurate claims adjudication. PRIMARY JOB RESPONSIBILITIES: Performs routine and focus audits on claim processing staff and auto-adjudicated claims to identify inaccurate claims adjudication. Assess accuracy and consistency of claims processed for each claims processor and random sampling of auto-adjudicated claims. Identify prevalent trends to management. Provide quality feedback to individual claims processors and to Supervisor through error reporting process. Collaborate with other Claims staff and leadership team on the use of established business processes, procedures and related tools. Work with claims leadership team to identify, develop, and implement business processes and tools used by staff to improve claim accuracy results. Work with claim processing staff to resolve difficult or complex claims, and recommend related training opportunities that improves claim payment results. Work with the...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
PRIMARY JOB RESPONSIBILITIES: Identify changes to State and/or Federal regulations, MCO contracts or NCQA requirements that may affect content of letters generated from Utilization Management and Complaints and Grievances activity. Participate in Market Meetings to understand Client requirements and communicate any items that impacts determination or appeal letters. Perform quality audits daily on determination letters. Communicate any potential errors identified in auditing determination letters to the identified contact person(s) for the area that generates the document. Identify non-compliant determination letters and communicate to Operations Management. Work with UM to have denials overturned if required by State/Plan if letters are non-compliant. Coordinate with UM and C&G to submit determination letters for audits in the required timeframe Coordinate with Correspondence System team to correct any process issues that may cause errors with determination letters identified...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Network Development Support Coordinator is responsible for supporting the network development department through several different areas, including provider communication delivery, provider giveaway management and coordination with outside vendors. This role will provide presentation support to the recruiters and management team for the purposes for internal and external meetings. The coordinator will manage multiple aspects of conference registrations, preparing formal documents utilizing MS Office suite of products to provide quality and timely materials. PRIMARY JOB RESPONSIBILITIES: Coordinate National conference attendee registration and booth support management. Create PowerPoint presentations and other formal documentation from recommended materials for internal and external presentations for network development, cost solutions, and leaders as needed. Provide printed materials and collate recruitment packets and prepare them for shipping to various sites. As needed,...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Operations Document Specialist Lead is responsible for the coordination of daily work assignments, quality review, and training for all administrative processes and administrative Utilization Management staff to ensure turn-around times are met for all markets. PRIMARY JOB RESPONSIBILITIES: Identify changes to State and/or Federal regulations, MCO contracts or NCQA requirements that may affect content of letters generated from Utilization Management and Complaints and Grievances activity. Responsible for outbound faxing process for Provider Determination Letters sent through Right Fax program. Oversight of output folders for Co-Router Accountable for interpretation and understanding of individual contract and state requirements as they relate to Notice of Action letters and Provider Determination letters Identify non-compliant determination letters and work with the UM Clinical Leads to have denials overturned if required by State/Plan if letters are non-compliant. Provide...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Supervisor, Vision Program will lead the vision contract execution process, make decisions as it relates to the vision network and support testing and reporting. The Supervisor, Vision Program must have the ability to motivate team members, drive change, and facilitate problem solving discussions as it pertains to process improvement, program and system implementations, communication and reporting. The Supervisor, Vision Program will provide follow up on projects, contract updates and changes, network, and reporting to the Manager, Vision Department. PRIMARY JOB RESPONSIBILITIES: Lead team responsible for completing Audits. Responsible for responding to client CAPs for vision and ensuring all CAP deliverables are coordinated and delivered in a timely manner Develops and submits IOD's based on CMS, market, or client specific program requirements Responsible for ensuring CMS, State, and Contractual requirements and SLAs for vision are met and changes are implemented as it pertains...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The DentaQuest Information Technology Service Desk provides enterprise support for employees, contractors, and consultants via a 3-tiered model with staff resources distributed amongst their locations in Massachusetts, Wisconsin, Florida, Texas, South Carolina, and Westborough. The SD Associate 2 will perform traditional Helpdesk and desktop hardware/software support and deployments. The Service Desk team also participates in project deployments as necessary. Tier 2 level IT Support typically engineer desktop solutions/images, provide advanced desktop hardware/software administration and support, and performs basic network diagnostic and administrative tasks. They too will participate in projects as needed for developing desktop deployment strategies. Under limited supervision will triage and provide first level support for Service Desk Incidents and requests for the DentaQuest enterprise reported by phone and/or ServiceNow self-services. There will be phone support as part of the...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Contract Compliance Analyst manages all project coordination for operational changes including new business, benefit/program changes and team projects in the Vision division. The Vision Contract Compliance Analyst is responsible for client audits and presentation of vision team information to external and internal partners. This role handles internal audit review of vision systems and letters to ensure regulatory, client and program quality standards are met, and implements internal action plans for any updates needed based on audit findings. This role ensures program requirements are implemented and reviewed on an on-going basis. PRIMARY JOB RESPONSIBILITIES: Use appropriate tools to identify tasks needed to be performed to demonstrate Vision operation readiness. Coordinates audit compilation efforts for Vision to deliver accurate audit files in a timely fashion. Review all audit preparation materials and complete audits tools. Present information in person (or as required) to...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
Responsible for prioritizing and handling all critical & routine support functions for daily operations of the Vision team. This includes direct outbound provider and member outreach, claims processing and coordinating the handling of claims. Projects a professional company image and provide superior customer service. PRIMARY JOB RESPONSIBILITIES: Perform provider outreach by phone and create detailed documentation and reporting for all projects. Identifies and handles follow-up with providers for missing claim information. Appropriately document necessary call details in system. Coordinate handling of claims including scanning claims, entering claims, member research, file attachments, coordination with clinical staff for fee amounts and claims processing. Routes mail and electronic information such as faxes and email to the correct system(s) or area. Manipulate information as required to move from one system to another. Process and pay claims in a timely and accurate manner...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
Primary responsibilities will include overseeing the Credentialing Standards & Compliance team and all related processes. Responsibilities include coordinating all client audits regarding Provider data and credentialing, all audit support, the timely and accurate production of all client reports, the coordination of site reviews, NCQA accreditation process and support, committee oversight, coordination, and support, internal training of Enrollment & credentialing specialist on Credentialing standards and all applicable documentation. PRIMARY JOB RESPONSIBILITIES: Ensure DentaQuest’s credentialing process meets client expectations and State regulations and NCQA requirements. Perform delegated credentialing audits as needed. Ensure all Applications and Site Evaluations are tracked. Ensure reports are prepared accurately, timely and work to automate the reports where applicable. Allocate resources appropriately to complete special projects timely and to meet deadlines. Review...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
JOB SUMMARY: The Customer Service Director ensures that all specialty markets are serviced with accuracy and efficiency by maximizing resources through shared utilization across all specialty markets. This Director works closely with Dental management to reduce loss ratio through appropriate PCD assignments. Minimizing/reducing reliance on regular and temporary staff by leveraging co-sourcing partnership to meet service level expectations is another responsibility of this Director as is managing the expectations and performance of the co-sourcing vendor. The Director achieves superior call center performance with respect to customer service through an integrated process of operational, quality, and resource management that meets or exceeds member, customer, and provider expectations and is consistent with corporate goals. PRIMARY JOB RESPONSIBILITIES: Work with co-sourcing vendor to maximize utilization by identifying call types that can be outsourced. Understand all contractual...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
JOB SUMMARY: The Operations Document Specialist I coordinate the printing and mailing of determination letters. The incumbent also coordinates efforts with internal staff to resolve issues. These areas may include Utilization Management. All Operations Document Specialists are expected to meet the guidelines and turnaround times relating to determination letters set by state regulations and/or Plan contracts. PRIMARY JOB RESPONSIBILITIES : Perform quality audits daily on determination letters Communicate any potential errors identified in auditing determination letters to the identified contact person(s) for the area responsible for the process that generated the letter Identify non-compliant determination letters and communicate to Operations Management. Work with UM to have denials overturned if required by State/Plan if letters are non-compliant Coordinate with UM and C&G or with Client directly to submit determination letters for audits in the required timeframe Coordinate...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Digital Services Representative I is responsible for a significant variety of critical functions necessary to support day-to-day claims intake operations. This position is responsible for ensuring DentaQuest meets all guidelines and turnaround times set by state and federal regulations and/or plan contracts specific to Intake Primary Job Responsibilities Accountable for robust understanding of, Commercial, Vision as well as State & Health Plan business clients, client requirements, claim & UM policies, and procedures that relate to Intake Accept, sort and log mail deliveries from USPS, FedEx and other couriers Open and sort incoming mail accurately into appropriate categories for further mail preparation Prepare paper claims, authorizations, and x-rays by ensuring correct procedures are followed Accurately identify specific document types and ensure they are appropriately identified and organized Basic document scanning for business docs such as Cred, Appeals & Fraud...
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Vision Provider Engagement Coordinator should act as the primary point person for providers to improve their understanding of our benefit programs, policies and procedures. This position is responsible for provider networks with regard to office education, technology promotion and general on boarding of newly contracted providers. This role is critical to maintaining accurate provider data in all systems. PRIMARY JOB RESPONSIBILITIES: Set up and maintain accurate and clean provider information in all vision systems. Educate providers on program, benefits, processes and administration questions. Handle all escalated provider issues to resolve including coordinating with internal and external resources. Ensure provider updates are handled according to CMS, Client and Regulatory requirements and documented/filed appropriately. Audit provider set up to ensure completeness and accuracy for all programs in all system(s). Create and distribute communication for providers as required....
Jan 22, 2022
DentaQuest Milwaukee County, WI, USA
The Member Enrollment Analyst handles all processes related to membership, including eligibility EDI (EE), online enrollment (OE), and manual requests, and ensures membership accuracy within the system. Works collaboratively with external clients on their EE and OE submissions to provide education and ensure standards are met. Researches and resolves membership issues through professional interaction with appropriate external client contacts and other internal stakeholders. Handles clients’ membership implementations, from onset to implementation, and maintains consistent communication to stakeholders. PRIMARY JOB RESPONSIBILITIES: Document client-specific eligibility business rules using tools such as Word, Visio and Excel; communicate business rules to IT. Understand and utilize the IT applications and tools used to support data mapping, business rules, and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules....
Apr 27, 2021
DentaQuest Milwaukee, WI, USA
Remote Opportunity: 1Requisition Number: 3576Position Title: Developer, LeadExternal Description:POSITION SUMMARY:Creates, modifies and maintains application programs in response to the changing needs of DCPG. Works with end users to achieve optimal results toward completion of each project.ESSENTIAL JOB FUNCTIONS:Under general direction:Coding, testing and debugging programs according to requirement specifications.Modifying, expanding and updating applications.Diagnosing and fixing bugs found by end users.Developing software prototypes.Communications with a team that includes analysts, engineers and quality assurance testers in order to coordinate and document application development and testing.Acting as a technical mentor and advisor for the development team.Providing creative vision and managing the planning and implementation of web-based applications.Overseeing application coding and providing technical expertise and mentoring other developers.Performs other duties as...