Dental Benefit Examiner
About the position
The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.
Responsibilities
ā¢ Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions
ā¢ Processes referral requests in accordance with clinical review criteria
ā¢ Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns
ā¢ Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing
ā¢ Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary
ā¢ Communicate with providers on member-related issues
Requirements
ā¢ Two years of dental administrative/clinical experience required
ā¢ High school degree or equivalent GED required
ā¢ Dental administrative/clinical experience
ā¢ Ability to read and interpret dental x-rays
ā¢ Computer experience in Microsoft Excel, Word, Outlook
ā¢ Knowledge of Medicaid and Medicare regulations and guidelines
ā¢ Knowledge of dental coding and terminology
ā¢ Knowledge of HIPPA regulations
ā¢ Effective time management skills
ā¢ Effective interpersonal and communication skills
ā¢ Ability to prioritize work tasks to adhere to deadlines and identified time frames
ā¢ Ability to work cooperatively, positively, and collaboratively in a team environment
Nice-to-haves
ā¢ Minimum one year of experience in a managed care organization or related healthcare delivery system
ā¢ Dental assisting certification preferred
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Apply To this Job
The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.
Responsibilities
ā¢ Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions
ā¢ Processes referral requests in accordance with clinical review criteria
ā¢ Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns
ā¢ Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing
ā¢ Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary
ā¢ Communicate with providers on member-related issues
Requirements
ā¢ Two years of dental administrative/clinical experience required
ā¢ High school degree or equivalent GED required
ā¢ Dental administrative/clinical experience
ā¢ Ability to read and interpret dental x-rays
ā¢ Computer experience in Microsoft Excel, Word, Outlook
ā¢ Knowledge of Medicaid and Medicare regulations and guidelines
ā¢ Knowledge of dental coding and terminology
ā¢ Knowledge of HIPPA regulations
ā¢ Effective time management skills
ā¢ Effective interpersonal and communication skills
ā¢ Ability to prioritize work tasks to adhere to deadlines and identified time frames
ā¢ Ability to work cooperatively, positively, and collaboratively in a team environment
Nice-to-haves
ā¢ Minimum one year of experience in a managed care organization or related healthcare delivery system
ā¢ Dental assisting certification preferred
Apply tot his job
Apply To this Job