Clinical Review Dentist

Primary Responsibilities

• Review of claims and supporting clinical data to provide accurate documentation for the dental director
• Accurate interpretation of radiographs, intra-oral photographs and clinical narratives
• Maintain organization and department defined standard of performance to meet metrics
• Communicate with provider offices in accordance with compliance regulations to discuss adverse clinical determinations and to request missing information
• Independently manage individual queue assignments and workflow to meet deadlines, business needs and department and individual metrics
• Act as a liaison between our dental directors and provider offices to maintain provider/member satisfaction
• Perform individual case review for appeals and grievances
• Participate in peer-to-peer calls with dental providers

Requirements

• Dental degree from an Accredited Dental School
• Active dental license
• 7+ years of experience in clinical dentistry
• 3+ years dental benefit plan experience with specific exposure to claim review and utilization management or comparable experience
• Ability to pass a credentialing review for practice experience
• Computer proficiency
• Excellent business analytical and writing skills

Qualifications

• Strong knowledge of dental procedures, terminology and related dental codes
• Strong computer and communication skills
• The work hours for this position will be from 10 am-7 pm CST and will include 8 hours of coverage every 4th Saturday/Sunday

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

Pay and Schedule

• The salary for this role will range from $112,700 to $193,200 annually based on full-time employment
• Working during the weekend will give you a day off during the week

Schedule

• The work hours for this position will be from 10 am-7 pm CST and will include 8 hours of coverage every 4th Saturday/Sunday