Document Service Representative

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. This includes performing a detailed mail sort, batch preparation, and scanning of all incoming claims and correspondence in order 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 in order 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, as well as capture all required data elements in FormWorks as defined by each individual business area in CDPHP to ensure accurate image routing into Macess EXP folders as well as to ensure the accurate creation and routing of workflow items in the Macess EXP doc flo system. 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.

QUALIFICATIONS:

• High school diploma or GED required. Associates degree preferred.
• Six (6) months alphanumeric data entry experience in a healthcare setting is 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 is highly preferred.
• A minimum of one year office experience with strong PC skills and Microsoft Windows is preferred.