OVERVIEW OF POSITION: The Professional Services Representative is responsible for providing customer service to the dental community related to provider maintenance, education, network development and support. This position will also be responsible to establish and maintain demographic data among various network affiliations and provider databases to support the enterprise.
DUTIES & RESPONSIBILITIES:
- Responsible for establishing and maintaining demographic data per network affiliation within multiple provider databases for claims payment and the publication of provider network directories. This complex process requires applying business rules to complete requests, cross-checking existing databases, primary source verification and accurate data entry.
- Responsible for processing dental network agreements within guidelines, review applications for thoroughness, communicate with the offices that fail to complete the application in its entirety, verify information and execute provider contracts.
- Provide courteous, professional, and confidential service to dental professionals by telephone, electronic/written or in person.
- Respond to dental office inquiries regarding network information, rules and regulations, policy and procedures, provider issues, change requests, and claim related inquiries.
- Responsible for processing electronic funds transfer enrollment, including establishing and maintaining bank records.
- Responsible for updating and maintaining provider taxpayer identification records, respond to related data and financial inquires and re-issue 1099 forms.
- Responsible to provide provider portal registration assistance, provider education and guidance to enable providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools and troubleshoot portal technical issues.
- Accurately and efficiently complete a range of audits including, but not limited to: Provider Maintenance and Directory Accuracy.
- Provide internal support to Professional Relations related to network development, service, and retention.
- Provide support for initial credentialing and annual re-credentialing activities.
- Respond to requests from other departments, dental offices, and other Delta Dental member companies.
- Responsible for document preparation of physical and digital documents for electronic storage and indexing.
- Accurately complete and maintain logs, forms, and reports.
- Meet and maintain productivity and performance standards for all activities.
- Demonstrate regular and consistent attendance and punctuality.
- Perform other job-related duties as assigned.
- Participate in team meetings and successfully complete mandated employee training.
- Access EPHI following most current versions of the Privacy and Security Manual, Enterprise Information Technology Policies, Employee Handbook, and Code of Ethics and Business Conduct.
