Temporary Document Services Representative at CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC

Latham, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Jan, 26

Salary

0.0

Posted On

14 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Data Entry, Claims Examining, Problem Solving, Time Management, Attention to Detail, Communication, Microsoft Windows, CPT-4, HCPCS, ICD-9, Scanning, Alphanumeric Data Entry, Regulatory Compliance, Customer Service, Office Experience, Macess, FormWorks

Industry

Insurance

Description

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience. The Document Service Representative shall assume full responsibility for the completion of the necessary activities related to the processing of incoming mail for the entire organization, as well as the timely and accurate facilitation and handling of all incoming paper claim and correspondence documents. All tasks are performed on-site. This includes performing a detailed mail sort, batch preparation, and scanning of all incoming claims and correspondence to facilitate and ensure compliance with all New York State regulations, including prompt pay and to ensure accurate image routing to the appropriate business area to support CDPHP’s customer service levels. Ownership is assumed for all aspects of claims examining and data entry on the FormWorks system, utilizing and interpreting Desk Levels to accurately examine and data enter claims via OCR, Key from Image, and Key Entry. Required data elements as defined by each business area must be accurately captured in accordance with departmental Desk Levels, ensuring images are filed appropriately in Macess and work items are routed to the correct doc flo queue for handling by each business area. The Document Service Representative will work closely with Member Services, Provider Services, Claims Operations, and Medical Affairs to resolve claims examining and correspondence data entry issues. The Document Service Representative will also be required to successfully apply problem solving and time management methodology to balance multiple tasks as business needs arise while maintaining production and quality standards. This role is a full-time temporary role with CDPHP. Qualifications: * Six (6) months alphanumeric data entry experience in a healthcare setting is required. * High school diploma or GED required. * Minimum of (1) year claims examining procedural review experience utilizing CPT-4, HCPCS, and ICD-9 codes is highly preferred. * Experience with review, interpretation and scanning of correspondence from multiple sources is highly preferred. * Experience or working knowledge with an on-line data entry system, especially Macess EXP and FormWorks , Web key is highly preferred. * A minimum of one year office experience with strong PC skills and Microsoft Windows is preferred. * Demonstrated ability to determine, analyze, and solve problems related to claims examining, correspondence and data entry . * Ability to successfully apply problem solving and time management methodology and balance multiple tasks as business needs arise. * Ability to apply CDPHP’s specialty claims handling and data entry Desk Levels with adherence to department turnaround time frames to ensure regulatory compliance. * Demonstrated ability to effectively communicate on both a verbal and written basis. Must utilize appropriate grammar, spelling, punctuation, and sentence structure in all written communications. * Strong attention to detail and ability to meet established quality and production standards while maintaining department turnaround time frames. * Ability to work independently with minimal supervision is required. As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status. CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.

Responsibilities

The Document Service Representative is responsible for processing incoming mail and handling all incoming paper claims and correspondence documents. This includes mail sorting, batch preparation, scanning, and ensuring compliance with New York State regulations.