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