Delta Dental of Arkansas

Representative

• Process enrollment forms/spreadsheets for new and existing groups including COBRA
• Process change of address forms
• Review and process enrollment changes including adding/removing dependents and effective/term date adjustments
• Research and correct ID cards returned with missing addresses
• Addresses vision error reports
• Assist in working electronic group error reports when necessary
• Quality assurance review of enrollments for other Eligibility Representatives
• Maintain communication with all internal departments and employer groups
• Support training of new Enrollment employees
• Completes special projects as assigned by management; performs tasks necessary to ensure efficient and cost-effective operation of the eligibility department
• Review and update of automated reporting as assigned
• Work with groups, TPA’s and internal departments for TPA changes of EDI files, provide testing and approval for production
• Provide discrepancies for large and or complex groups
• Process EDI files as assigned
• Act as a liaison for groups and brokers regarding enrollment-related inquiries
• Address emails submitted to the Enrollment inbox as needed for back-up
• Process enrollment forms/spreadsheets for new and existing electronic groups as needed
• Ensure compliance with HIPAA and other regulatory requirements
• Support the eligibility call center

Enrollment Representative II

Supervisor

• Oversee day-to-day operations of a team consisting of all elements of the Credentialing process.
• Assist in ensuring the coordination of initial and ongoing compliance with National Committee for Quality Assurance (NCQA) and Delta Dental Plans Association standards.
• Ensures development and execution of Credentialing and other provider onboarding functions in accordance with applicable department policies and procedures.
• Work directly with provider services associates, providers and external clients to ensure satisfaction and timeliness.
• Generate performance measures and set goals while monitoring performance against them.
• Coordinate directly with the Director of Compliance to ensure alignment with all departmental and company initiatives.
• Monitor key performance indicators and metrics to assess provider enrollment & credentialing effectiveness, efficiency, and compliance.
• Responsible for continuous process improvement in provider enrollment and credentialing processes.
• Maintain all providers’ contractual credentialing information for all Networks including Medicare Advantage and Medicaid.
• Run regularly scheduled reports to identify and address any outstanding applications, issues, and expiring information.
• Assist in development, implementation and maintenance of processes that support department and organization goals.

Credentialing Services Supervisor

Customer Support

• Manage incoming calls and customer service inquiries.
• Provide outstanding customer service that meets the needs of the department standards and performance metrics.
• Demonstrate exceptional verbal and written communication.
• Build relationships and trust with customers through open and interactive communication.
• Learn, retain, and effectively use appropriate systems, programs, and dental knowledge to resolve inquiries.
• Access and utilize reference material and other resources to analyze and determine appropriate responses to complex telephone, electronic, and written inquiries.
• Create thorough call documentation and follow up on open calls to ensure resolution is achieved within agreed upon standards.
• Continuously evaluate and identify opportunities to drive process improvement that increase customer satisfaction.
• Must clock in and out as scheduled.

Enrollment Representative II

Credentialing Services Supervisor

Customer Service Representative