20 days old

Operations Documentation Specialist II (onsite in Milwaukee with some remote work)

DentaQuest
Milwaukee, WI 53202 Work Remotely
  • Job Code
    3411

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.



Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.



To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.



The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve 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.



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 with Client to ensure determination letters are translated to the required language(s).
Coordinate the reprint and deletion process for any determination letters that had updates applied.
Batch and print member determination letters and prepare for mailing.
Assist Supervisor with requests from Client for determination letter information
Provide assistance to other departments with determination letter requests
Research and coordinate file requests for client audits.
Maintain departmental process documents.
Performs clinical peer reviews
Other duties as needed or required.

JOB QUALIFICATIONS:

Required:
High school diploma
One year of related experience
Ability to prioritize and organize multiple tasks.
Ability to work independently.
Good PC Skills.
Good Analytical ability
Strong attention to detail
Typing skills of 30+ wpm.
Excellent verbal and written communication skills.
Ability to remain organized with multiple interruptions.
Good knowledge of Word and Adobe PDF Writer programs
Attends additional training as requested/deemed necessary

PHYSICAL DEMANDS:
Incumbent must be able to communicate effectively.
Requires overall light physical effort (up to 25lbs.)
Manual dexterity and sitting are required in carrying out the position's own position responsibilities (i.e. use
of a personal computer).
Ability to travel or move about within and outside serviced facilities required.
Incumbent works primarily in either a private or shared office environment.







Posted: 2021-02-08 Expires: 2021-03-09
Sponsored by:
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Sponsored by:
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Operations Documentation Specialist II (onsite in Milwaukee with some remote work)

DentaQuest
Milwaukee, WI 53202

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