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Claims Review Specialist
Responsible for the review and claim adjudication of complex claims, dental office adherence to claim processing policies, and working with the Dental Consultants to review aberrant treatment profiles. In addition, this position is responsible for representing Delta Dental of Wyoming on clinically designated matters as appropriate, both internally and externally, and will work collaboratively in a customer-focused manner to ensure Delta Dental’s high quality service values are consistently delivered. Responsible for communicating with dental offices for effective issue resolution and explanation of clinical or administrative policy as required, answering of complex claims processing questions from stakeholders and adhering to processing standards related to quality, documentation and turnaround time. Must be able to maintain strict confidentiality; adhere to all HIPAA laws and to complete special projects on time with high quality.
Licensed Dental Hygienist with a minimum of 2-4 years experience in a dental office or insurance company with specific knowledge of CDT coding and nomenclature. Benefit plan contract language and claims administration computer system experience preferred. Demonstrated knowledge of claims processing and dental treatment procedures, including the ability to read clinical records including: radiographs, periodontal charting and treatment notes. Knowledge of alternative dental treatment techniques preferred.
Please submit resume to Patricia Guzman at firstname.lastname@example.org by June 12, 2015.
Claims Review Specialist Full Job Description
Exchange Certified Plans
For more information on Exchange Certified Individual or Small group (50 employees or less) Dental Plans, please contact our office at 800-735-3379 or 307-632-3313. You can also visit our Health Care Reform page for more information.
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