Responsible for performing utilization review of dental claims, including interpretation of radiographs, patient histories and other records to ensure consistent application of and compliance with policy, departmental guidelines, and client contracts.
Location: This position will work remote (remote) and must live within 50 miles of one of our Pulse Point office locations.
How will you make an impact:
Makes independent claim decisions regarding benefit eligibility, requests additional information as needed and hand off to dental consultants if a decision needs to be made regarding medical necessity.
Provides expert analysis to dental Grievance and Appeals and Customer Service as requested.
Participation in team efforts regarding process improvement/efficiencies.
Minimum requirements:
Requires BA/BS and minimum of 2 years of experience; or any combination of education and experience, which would provide an equivalent background.
Dental assistant certificate required.
Preferred Skills, Capabilities, and Experiences:
Current license as a Dental Assistant or Dental Hygienist
Minimum of three years of experience in a clinical setting.
Detailed knowledge of dental procedures and coding preferred.
