Document Service Representative

Payrate: $18.00 - $19.32/hr.

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 customer service levels.

Ownership is assumed for all aspects of claims examining and data entry on the Form Works 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.

• 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 Form Works OCR error correction, Key from Image, and Key Entry on all medical, hospital, dental, and vision claims in accordance with departmental desk levels
• Perform accurate Form Works 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 area
• Report 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 metrics
• Report any obvious provider billing problems observed
• Provide value-added feedback regarding established desk levels and train newly hired staff when required. Maintain the production and accuracy ratio as established by the department
• Re-direct claims and correspondence to the appropriate resource/department as needed in accordance with established Desk Levels
• Research and contact appropriate resources as warranted for information necessary for the completion of examining and/or data entry utilizing the corporate documentation system
• Initiate and assist in the development of process improvements necessary to resolve claims examining and data entry issues and system limitations
• Perform all scanning room functions, this includes but is not limited to sorting, prepping, and scanning of all claims and correspondence documents into Form Works in accordance with established desk levels
• Archive all incoming claim and correspondence documents in accordance with established Desk Levels
• Complete the daily rejection report, including retrieval of archived claim and correspondence documents, within established time frames
• Verify scanned documents for completeness
• Report any system, filing, scanning, or workflow issues to the Team Lead, Document Management, and/or a member of management as appropriate
• Perform 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 procedures
• The employee agrees to comply with company’s Corporate Compliance Policy, and all laws, rules, regulations and standards of conduct relating to the…