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Dental Reviewer in Bloomington, MN at KEPRO

Date Posted: 1/8/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
    Other
  • Experience:
    Not Specified
  • Date Posted:
    1/8/2018

Job Description

KEPRO, INC.

JOB DESCRIPTION

JOB TITLE:            DentalReviewer

REPORTS TO:      OperationManager

DEPARTMENT:  Operations

FLSA STATUS:     Nonexempt

Summary Description

Reviews patient information to ensure treatment/serviceprovided falls within the plan guidelines and that the service was appropriatefor the condition. 

Accountabilities

  • Review x-rays, patient charts and other patientrecords to ensure treatment/service provided is within guidelines of the plan.
  • Review preauthorization paperwork to ensure theintended treatment meets the dental plan criteria and relevant programcriteria.
  • Maintain accurate and detailed notes of workperformed in the databases
  • Contact provider offices to obtain additionalinformation as needed.
  • Respond to questions from internal and externalcustomers in a through and timely manner utilizing communication that is easilyunderstood by others.
  • Enter new authorization determinations, guidelinesand denial reasons into company systems to ensure successful implementation ofnew clients
  • Utilize resources available to assess issues(set up, system, etc.) and locate appropriate resolution.
  • Utilize resources available to maintain currentknowledge and understanding of dental plans and coverage provided.

The list of accountabilities is not intended to beall-inclusive and may be expanded to include other duties that management maydeem necessary from time to time

Qualifications

  • Licensed Dental Hygienist
  • Current X-ray license

Abilities

  • Ability to communicate effectively (verbal andwritten) persons of diverse backgrounds and educational levels.
  • Excellent organization and interpersonal skillsrequired.
  • Excellent problem solving skills to allow forthe correct diagnosis of a problem along with potential solutions forresolution.
  • Skilled in working with others in a teamenvironment.
  • Must be proficient in MS Office applications(Word, Excel, PowerPoint, and Access).

Experience

  • Minimum 5 years of experience in a clinicaldental role or other similar related experience.
  • Knowledge of dental procedures, terminology andcodes.

Mental and PhysicalRequirements        

The physical demands described here are representative ofthose that must be met by an employee to successfully perform the essentialfunctions of this job.  Reasonableaccommodations will be made as required by law in an attempt to enable anindividual with a disability to perform the essential functions of this job.While performing the duties of this job, the employee is regularly required tosit for prolonged periods of time; key and/or control objects; interactextensively with internal and external customers; occasionally lift and/or moveobjects weighing up to 10 pounds; and occasionally travel.

Equal Opportunity Employer

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