Clinical Review Support Specialist

The opportunity

The Clinical Review Specialist I provides timely and accurate review and authorization of dental services based on eligibility and contract requirements.

How you will contribute

• Successful completion of the Clinical Review Specialist training program
• Read, interpret and analyze x-rays, models and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language
• Resolve claim and prior authorization suspends that require UM Review
• Consistently meet productivity requirements
• Maintain audit score of 95% or greater
• Pass the IRR quarterly
• Communicate and work effectively with co-workers and Leads to coordinate workload to ensure all work is completed daily
• Knowledge of reference materials and documentation that contain market nuances
• Respond to follow-ups
• Provide customer service via the telephone to providers regarding clinical issues
• Other duties as assigned
• Represent DentaQuest in a professional manner at all times
• Adhere to DentaQuest business processes
• Performs peer clinical reviews

What you will bring with you

• High School Diploma or equivalent
• 1 year dental assisting experience
• Ability to read and interpret x-rays, dental models, photos, and/or patient charts
• Good interpersonal skills
• Ability to work independently
• Excellent oral and written communication skills
• Efficient PC skills (Word, Excel, Outlook)
• Ability to prioritize and organize multiple tasks
• Ability to remain organized with multiple interruptions
• Knowledge of telephone systems
• Ability to work in excess of 40 hours in a week
• Required to attend additional training as required/deemed necessary
• Previous dental insurance experience a plus

Pay

$38,200 - $51,600

Benefits

• Generous vacation and sick time
• Market-leading paid family, parental and adoption leave
• Medical coverage
• Company paid life and AD&D insurance
• Disability programs
• Partially paid sabbatical program
• 401(k) employer match
• Stock purchase options
• Employer-funded retirement account
• Flexible, inclusive and collaborative work environment that supports career growth