Vision Provider Recruitment Billing and Reporting Specialist

Primary responsibilities include assisting with all Claims Operations, Network Development, and Customer Service for DentaQuest's vision business. This position is critical to establishing and maintaining all functions within the vision business unit under the direction of DentaQuest's Vision Director.

JOB Responsibilities:
Network Development activities in new and existing markets
Recruit non participating providers to join our networks via mailings, phone, email, fax and on-site visits.
Negotiate standard and special deal contracts to establish and maintain compliance and increase access in weak networks.
Instruct providers on the importance of submitting all credentialing documents in a timely manner with complete information.
Ensure complete credentialing packages are submitted and obtain any missing information from providers.
Develop and maintain a personal working relationship with key individuals and decision makers at provider offices
Interact with providers and meet to resolve issues and meet needs
Maintain and submit all required reports for network development
Develop complete understanding of the Provider Office Reference Manuals and assist in creating/updating ORMs
Process claims in workflow and generate payment runs to pay providers in a timely manner and as per client requirements
Ensure claims are paid in a timely manner as per client and state requirements
Troubleshoot claims and payment issues as appropriate
Work with providers, client account executives and Finance to address issues with payment runs
Generate reports as per client and state requirements
Assist with implementation process for all new Vision clients
Mentor and train individuals in the Vision Customer Service Representative role
Back up call center team as needed
Contribute to team effort by completing related projects as needed
Other duties as assigned
Required Experience
Bachelor's degree in business related field, or equivalent experience in healthcare management
5+ years related experience required.
General knowledge of vision and eye care is a plus
Knowledge of benefits and insurance
Experience with CPT and ICD Coding
Knowledge of Provider Recruitment
Knowledge of Provider Credentialing a plus
Claims Payment & Customer Service Experience
Excellent interpersonal skills.
Excellent written and verbal communication skills.
Good PC Skills - Word and Excel specifically
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions
Ability to work independently and as part of a team.
Strong presentation/sales skills.
Phone Sales experience preferred.
Ability to make good judgments based on data available with minimal supervision.
Ability to work in high-pressure environment with tight deadlines for results.
Job Location
Grafton, Wisconsin, United States
Position Type

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