POSITION SUMMARY

Primary contact for answering and responding to incoming calls, emails and faxes from providers and their staff related to HDS Medicaid. Responsible for the timely and accurate preparation, review and follow-up updating the weekly Med-QUEST file to ensure that the HDS Medicaid system is current and up to date. Accurately maintains dentist data on the local HDS Medicaid systems. Accurately enrolls and terminates user access to the secured HDS Medicaid online portal. Handles miscellaneous tasks assigned by the Professional Relations Manager or Director of Professional Relations. Must be able to prioritize tasks and work independently with minimal supervision. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Key Responsibilities

• Updates the HDS Medicaid database with information received from the Med-QUEST office weekly. Coordinates with the Med-QUEST provider relations department in resolving provider registration issues.
• Maintains and performs daily updates to dentist’s information in the database in an accurate and timely manner in the HDS Medicaid system.
• Answers in a timely and professional manner the Professional Relations phone line, faxes, messages, and emails addressing questions, issues from both internal and external customers as they relate to the HDS Medicaid business. Must understand and be able to communicate the requirements of the HDS Medicaid provider contract documents and required documentation for service office registration and online registration.
• Works with the claims department to resolve provider data issues that affect claims processing. 
• Enrolls and terminates HDS Medicaid online users.
• Works with the claims department to resolve provider data issues that affect claims processing.
• Ensures all Medicaid fees schedules are up-to-date and accurately inputted into the HDS Medicaid system in a timely manner. 
• Communicates Medicaid network changes to the Professional Relations department.
• Identifies needs and promotes HDS Medicaid services to external customers when opportunities arise (for example, Direct deposit, E-claims, ERA).
• Prepares and mails provider correspondence related to HDS Medicaid activities. 
• Scanning and maintenance of HDS Medicaid dentists’ electronic files.

Other Duties and Responsibilities

• Performs call outs as necessary to communicate miscellaneous issues.
• Assists with audit requests, related to HDS Medicaid. 
• Prepares and maintains inventory of HDS Medicaid materials for distribution by Professional Relations representatives at their site visits.
• Accomplishes special projects as assigned, including but not limited to the HDS Medicaid Newsletter.
• Assists in HDS Medicaid provider functions such as the Hawaii Dental Association convention.
• Other duties and responsibilities as assigned by the PR Manager or Director of PR.

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

High School degree with post-secondary education emphasis in business administration or public administration is preferred.

Experience

At least three years of clerical/administrative experience, customer service or sales in the health care or insurance fields. 

Dental office or Medicaid experience is preferred.

Skills and Knowledge

• Working knowledge of PC applications (i.e. word processing and spreadsheets) highly desirable.
• Requires demonstrated customer service skills and sales ability.
• Ability to maintain focus and attention to detail.
• Ability to handle multiple tasks with distractions.
• Ability to communicate orally and in writing with all levels of staff, customers and vendors.
• Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e., HIPAA, PHI).

Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.