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If you're excited about the potential of technology to transform the dental insurance industry and collaborate with diverse and passionate people to deliver extraordinary experiences for our customers, we encourage you to apply for this opportunity to join the Advance Health Services team!

The Business Operations Analyst will work with Software Developers, QA Analysts, and our customers to ensure the effectiveness and accuracy of our proprietary ERP systems (ProClaim) output. This position will review and analyze claims, review plan design setups, execute tests, and perform a thorough review/analysis of business requirements and test failures to identify ways in which our software applications can be enhanced to deliver maximum value to our customers.

ABOUT AHS:

Advanced Health Services, LLC (AHS), a wholly-owned subsidiary of Delta Dental of Idaho, is an Idaho-based company providing information technology services and support for organizations in the healthcare industry. Here you'll use your technology skills to help improve the oral health of our community.

AHS offers the following services:

• SaaS offerings in the healthcare space
• Business intelligence and data analytics
• Cybersecurity program development and management
• IT network and help desk management

We have a flexible, forward-thinking culture with trust at its heart. What does that mean? Our working model provides employees opportunities for brainstorming, team building, and co-creating balanced with options to work from home. We understand that personal preferences, work contexts, and key tasks all impact where team members feel most energized, whether at home or in the office. Join our team committed to making a difference in people's lives while working in an environment full of challenge, collaboration, flexibility, and industry-leading growth potential.

ESSENTIAL FUNCTIONS

• Review claims that the system is unable to auto-adjudicate and ensure proper final result.
• Oversee vendor performing manual claim data entry, including coordination or resolution of all rejected claims.
• Serve as subject matter expert and primary point of contact/escalation for the following:
  • Plan setup/configuration and claims processing policies.
  • Benefit materials.
  • Provider portal functionality.
  • Orthodontia contracts and claims.
  • Data exchanges/integration with Delta Dental Plans Association and other entities.
• Investigate claim processing and/or plan configuration defects, determine proper course of action, and collaborate with IT team to ensure timely resolution.
• Collaborate with IT colleagues and customers to identify, scope and document requirements for system enhancements related to plan configuration, claims processing, reporting and more.
• Perform/coordinate testing of changes to the ProClaim application that affect claims adjudication, benefits & eligibility reports and/or website functionality.
• Identify opportunities to improve the auto-adjudication logic of the ProClaim system to reduce the number of pended claims.
• Provide training as needed to customer staff members.
• Monitor auto-adjudication SLA metrics and communicate status of claims backlog on a regular basis.
• Demonstrate a commitment to the organizations vision, mission, values, code of ethics, and compliance/security standards.
• Other duties as assigned

Requirements

KNOWLEDGE, SKILLS, AND ABILITIES

• At least two (2) years experience working in a dental office, processing dental claims, or working with dental claims software.
• Working knowledge of ADA common dental procedure codes.
• Familiarity with one or more of the following technologies a plus:
  • Dental Practice Management software
  • Claims processing software such as TriZetto Facets, Plexis, etc.
  • JIRA
• Strong analytical and critical thinking skills.

• Ability to work either independently or as part of a team.
• Ability to communicate well, both verbally and in writing with all levels of internal and external customers.

PHYSICAL AND MENTAL REQUIREMENTS

• Sitting/Standing (alternatively) continuously
• Keyboard Use/Repetitive Hand motion continuously
• Skill/ability related to comprehension, organization, reasoning/decision-making and communication appropriate to position/level

Benefits

Advanced Health Services offers a competitive benefits plan including:

• Medical, dental, and vision
• 401K with up to 6% company contribution
• Generous PTO and up to 9 paid holidays
• Community Service Time
• Flexible, hybrid schedule and 1/2 day Fridays
• Tuition and continuing education reimbursement
• Casual dress code
• (link removed) more!

OUR CULTURE

AHS seeks to provide a positive workplace where employees are treated with respect and all are accountable for living our values and Code of Ethics while empowered to help the organization succeed in achieving its mission and vision.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Individuals that may need assistance with the applicant or interview process may contact human resources at jobs@ahsid.net or by phone: 208-488-7741.