Northeast Delta Dental

Title: Electronic Data Interchange Coordinator Location: Concord United States Job Description: Northeast Delta Dental in Concord, NH is seeking to hire a full-time, remote, Electronic Data Interchange (EDI) Coordinator who will provide accurate, secure, and expedited enrollment for employer groups and Third-Party Administrators (TPAs). Our EDI Coordinator position earns a competitive salary at $24.00 - $25.00/hour depending on experience. We provide fantastic benefits including health, life, dental, vision, short-term disability (STD), long-term disability (LTD), paid time off (PTO), paid holidays, a 401(k) plan, an independent retirement advisor, an employee assistance program, a tuition reimbursement program, and more! If this sounds like the right opportunity for you, apply today! ABOUT NORTHEAST DELTA DENTAL: Northeast Delta Dental - a nonprofit member of Delta Dental Plans Association (DDPA) - is the region's most trusted name in dental insurance for companies, individuals, and families throughout Maine, New Hampshire, and Vermont. A DAY IN THE LIFE OF AN EDI COORDINATOR: - Promotes accurate electronic file feeds by educating and training employer groups and TPAs about file formatting and requirements. - Implements electronic group enrollments by receiving and entering eligibility records into the custom enterprise system. Updates current records as needed. - Reviews enrollment data for accuracy by comparing and analyzing error reports and performing audits. Collaborates with TPAs and employer groups to reconcile discrepancies and update records. - Improves claims adjudication by performing scenario testing, researching errors, and updating enrollment data in the custom enterprise system. - Provides excellent customer service to employer groups by processing electronic eligibility files accurately and in a timely fashion; answering calls, and responding to email inquiries. - Provides training, guidance, and information on electronic enrollment by maintaining and enhancing knowledge about the process and rules around setting up and receiving 834 transactions, electronic enrollment files, the subscriber benefit administration tool, and eligibility modules in the custom enterprise system. - Maintains accurate process and procedure reference guides by documenting, reviewing, and updating department manuals, training materials, and related documentation. THE EXPERTISE AND SKILLS YOU WILL BRING: - Associates Degree in Business, Computer Science, or related field, plus at least two years of progressively responsible eligibility or enrollment experience or an equivalent combination of training, education, and/or experience. - Must be proficient in the use of the Microsoft Office suite. Experience with online enrollment tools, electronic enrollment file formats, and the Health Insurance Marketplace preferred. - Must be authorized to work for any employer in the United States without sponsorship now and in the future. WORK SCHEDULE: The typical work schedule for this position is Monday - Friday, 8:00 a.m. - 4:00 p.m. All candidates must be authorized to work for any employer in the United States without sponsorship now and in the future. Northeast Delta Dental is proud to be an equal opportunity employer. IF YOU ARE READY TO JOIN OUR TEAM ~ APPLY TODAY! Location: 03301

Role Description Join Our Award-Winning Team at Northeast Delta Dental as a Dental Claims Analyst! Our Claims Edit Department in Concord, NH is seeking a full-time, remote, Claims Analyst to assure accurate adjudication, refunds, and adjustments of dental claims by reviewing, researching, and/or returning suspended dental claims in accordance with appropriate departmental processes. The Dental Claims Analyst role offers a competitive hourly salary at $23.00 to $24.00 based on experience. Enjoy excellent benefits, including health, dental, vision, PTO, holidays, a 401(k), tuition reimbursement, and more! Some of the Responsibilities for this Role: - Adjudicates claims using Northeast Delta Dental and New England Dental Administrators, LLC, processing policies by reviewing, correcting, editing, and researching suspended claims; contacts dental offices, as necessary, to obtain routine missing information or to correct information. - Researches, corrects and processes claims queries. - Processes claims requiring special handling, special consideration, and manual pricing by following the applicable processes noted in the department manual outlined for specific programs/groups/benefits (for example, Ortho, Head Start, Exchanges, New England Dental Administrators, LLC). - Resolves Dental Coordination of Benefits (COB), Dual Delta, and medical claims based on coordination of benefits guidelines; ensures the accuracy of benefits allocation between primary and secondary dental and medical carriers. - Calculates refunds for the Customer Service staff, verifies coordination of benefits resolutions and provides information to questions about claims payments. - Assures appropriate documentation, X-rays, and/or any applicable notes are attached before forwarding claims to consultant review by reviewing claims and returning claims missing information to the dental offices. Qualifications - At least two years claims processing or insurance related experience, or an equivalent combination of training, experience, and/or education. - Must be proficient in Microsoft Excel and Word. - Must possess thorough knowledge of CDT coding and dental terminology. - Ability to perform routine mathematical computations and calculations. Requirements - All Candidates must be authorized to work for any employer in the United States without sponsorship now and in the future. Work Schedule - The typical work schedule for this position is Monday - Friday, 8:00 a.m. - 4:00 p.m. for this 37.5 hour per week position. Company Description Northeast Delta Dental is proud to be an equal opportunity employer.