Document Service Representative

Document Service RepresentativePayrate: $18.00- $19.00/hr. Summary: 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. 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 with 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.Responsibilities:Examine data enter and re-write all physician, hospital, dental, and pharmacy claims utilizing established policies and procedures as well as medical claims coding guidelines.Perform accurate Formworks OCR error correction, Key from Image, and Key Entry on all medical, hospital, dental, and vision claims in accordance with departmental desk levelsPerform accurate Formworks data entry on correspondence documents in accordance with departmental desk levels to ensure work items are filed appropriately in Macess and work items are routed to the correct doc flo queue for handling by each business areaReport any scanning, data entry, or workflow issues to the Team Lead, Document Management and/or a member of management as appropriate.Work mandatory overtime when deemed necessary to meet TAT service level metricsReport on any obvious provider billing problems observedProvide value-added feedback regarding established desk levels and train newly hired staff when required. Maintain the production and accuracy ratio as established by the departmentRe-direct claims and correspondence to the appropriate resource/department as needed in accordance with established Desk LevelsResearch and contact appropriate resources as warranted for information necessary for the completion of examining and/or data entry utilizing the corporate documentation systemInitiate and assist in the development of process improvements necessary to resolve claims examining and data entry issues and system limitationsPerform all scanning room functions, this includes but is not limited to sorting, prepping, and scanning of all claims and correspondence documents into Formworks in accordance with established desk levelsArchive all incoming claim and correspondence documents in accordance with established Desk LevelsComplete the daily rejection report, including retrieval of archived claim and correspondence documents, within established time framesVerify scanned documents for completenessReport any system, filing, scanning, or workflow issues to the Team Lead, Document Management, and/or a member of management as appropriatePerform general scanner maintenance as needed.Identify and report deviations in provider practice and billing to the Team Lead, Document Management Complete required department documents in an accurate and timely fashion as outlined in established proceduresThe employee agrees to comply with company's Corporate Compliance Policy, and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer.Performs other duties as assigned.Minimum Resource Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.Requirements:Demonstrated ability to determine, analyze, and solve problems related to claims examining, correspondence and data entryAbility to successfully apply problem solving and time management methodology and balance multiple tasks as business needs ariseAbility to apply specialty claims handling and data entry Desk Levels with adherence to department turnaround time frames to ensure regulatory complianceDemonstrated ability to effectively communicate on both a verbal and written basis. Must utilize appropriate grammar, spelling, punctuation, and sentence structure in all written communicationsStrong attention to detail and ability to meet established quality and production standards while maintaining department turnaround time framesAbility to work independently with minimal supervision is required.