Dental Reviewer

About This Role

This role involves reviewing patient dental records to ensure treatment aligns with plan guidelines and is appropriate for the condition, maintaining accurate records, and communicating with provider offices.

Responsibilities

• Review patient charts, x-rays, and other related records to ensure that the treatment provided is in line with the guidelines of the plan
• Check preauthorization paperwork to ensure that the intended treatment meets the criteria of the dental plan
• Maintain accurate and detailed records of the work performed in databases
• Communicate with provider offices to obtain additional information as necessary
• Respond promptly to inquiries from internal and external customers
• Enter new authorization determinations, guidelines, and reasons for denial into company systems
• Stay current on knowledge and understanding of dental plans and coverage
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Requirements

• Active, unrestricted, Registered Licensed Dental Hygienist (RDH)
• Current X-Ray license
• 5+ years of experience in a clinical dental role
• Ability to work weekends

Qualifications

• 5+ years of experience in a clinical dental role [e.g., Dental Hygienist (RDH), Registered Dental Assistant (RDA)]

Nice to Have

• Strong ability to communicate effectively with people from diverse backgrounds
• Excellent organizational and interpersonal skills
• Knowledge of dental procedures, terminology, and Current Dental Terminology (CDT) codes
• Excellent problem-solving skills to diagnose problems accurately
• Ability to work efficiently in a team environment
• Proficiency in Microsoft Word, Excel, and other applications

Skills

* Required skills