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The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.
Job Responsibility:
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 have:
Minimum one year of experience in a managed care organization or related healthcare delivery system