Claims Referral Specialist I

***THIS JOB IS ONSITE IN TAMPA-FL***

***Pay is $16.00 - $20.00 per hour DOE***

Job Summary

Responsible for daily processing of dental claims and/or pre-authorizations/referrals within plan timelines. Must be able to meet or exceed production goals and quality scores. Employee must maintain a professional demeanor and have good attendance. Job function may differ depending on area of assignment (e.g. claims, referrals, pre-estimates).

Job Summary Details

• Data Entry
• Benefit determination and claims or pre-authorization and specialty referral processing
• Maintain current knowledge of the service level agreements (SLA) and state regulations for processing purposes
• Promote and support a teamwork culture and environment
• Maintain a safe and productive working environment following established protocols
• Perform other duties as assigned or determined appropriate

Distinguishing Characteristics

• Distinguishing Characteristics (Levels I, II, III)
• Claims/Referral Specialist I: Able to process all claims for up to 2 lines of business per location with exception of COB and Ortho OR able to process all Pre-Authorizations and Referrals for 2 lines of business per location

Education Requirements:

Minimum

High School or GED

Preferred:

Registered Dental Assistant (RDA)

Minimum Years of Experience

1yr dental claim processing experience required

Specific Skills/Knowledge

· Working knowledge of Microsoft Office (Excel, Outlook, and Word)

· Demonstrated ability to work independently and meet objectives

· Type a minimum of 40 wpm

· 10-key by touch

· Strong communication, presentation and customer service skills

· Front/back office experience in a dental office preferred