[Hiring] Utilization Management Clinical Processor @LE701 Avesis, LLC
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Role Description
As a Utilization Management Clinical Dental Processor, you will leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations.
ā¢ Perform initial reviews of medical necessity cases, ensuring compliance with member eligibility and covered services outlined in each client contract.
ā¢ Utilize clinical criteria to approve or deny services based on authorization.
ā¢ Evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision.
ā¢ Apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies.
ā¢ Complete 13 to 18 cases per hour to meet client standards and contractual obligations.
ā¢ Complete clinical scripts, review patient histories, and import supporting documentation into the internal system.
ā¢ Work hours may vary based on location, department needs, and workflow; mandatory overtime may be required during peak seasons.
Qualifications
ā¢ High School Diploma/GED
ā¢ Dental Assistant or Dental Hygienist required
ā¢ Dental Assistant certificate or 2 years of chair side assisting
ā¢ 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required
ā¢ Proficiency with Microsoft Office and other Windows-based applications
ā¢ Strong reading, writing, and professional communication skills
ā¢ Ability to manage multiple tasks and prioritize work
ā¢ Adaptability to handle multiple and changing priorities
ā¢ Effective time management and organizational skills
ā¢ Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.
Requirements
ā¢ X-Ray certification is highly preferred.
ā¢ Knowledge of Medicare, Medicaid, or commercial insurance.
ā¢ Experience with HCPCS, CPT, CDT, and ICD-10 coding.
Benefits
ā¢ Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
ā¢ Competitive compensation package.
ā¢ Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
ā¢ Life and disability insurance.
ā¢ A great 401(k) with company match.
ā¢ Tuition assistance, paid parental leave and backup family care.
ā¢ Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
ā¢ Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
ā¢ Employee Resource Groups that advocate for inclusion and diversity in all that we do.
ā¢ Social responsibility in all aspects of our work.
Apply Now
Apply Now
Role Description
As a Utilization Management Clinical Dental Processor, you will leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations.
ā¢ Perform initial reviews of medical necessity cases, ensuring compliance with member eligibility and covered services outlined in each client contract.
ā¢ Utilize clinical criteria to approve or deny services based on authorization.
ā¢ Evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision.
ā¢ Apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies.
ā¢ Complete 13 to 18 cases per hour to meet client standards and contractual obligations.
ā¢ Complete clinical scripts, review patient histories, and import supporting documentation into the internal system.
ā¢ Work hours may vary based on location, department needs, and workflow; mandatory overtime may be required during peak seasons.
Qualifications
ā¢ High School Diploma/GED
ā¢ Dental Assistant or Dental Hygienist required
ā¢ Dental Assistant certificate or 2 years of chair side assisting
ā¢ 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required
ā¢ Proficiency with Microsoft Office and other Windows-based applications
ā¢ Strong reading, writing, and professional communication skills
ā¢ Ability to manage multiple tasks and prioritize work
ā¢ Adaptability to handle multiple and changing priorities
ā¢ Effective time management and organizational skills
ā¢ Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.
Requirements
ā¢ X-Ray certification is highly preferred.
ā¢ Knowledge of Medicare, Medicaid, or commercial insurance.
ā¢ Experience with HCPCS, CPT, CDT, and ICD-10 coding.
Benefits
ā¢ Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
ā¢ Competitive compensation package.
ā¢ Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
ā¢ Life and disability insurance.
ā¢ A great 401(k) with company match.
ā¢ Tuition assistance, paid parental leave and backup family care.
ā¢ Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
ā¢ Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
ā¢ Employee Resource Groups that advocate for inclusion and diversity in all that we do.
ā¢ Social responsibility in all aspects of our work.
Apply Now
Apply Now