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Dental Reviewer in Bloomington, MN at KEPRO

Date Posted: 10/19/2018

Job Snapshot

Job Description

Dental Reviewer

Summary Description

Reviews patient information to ensure treatment/service provided falls within the plan guidelines and that the service was appropriate for the condition. 

Accountabilities

  • Review x-rays, patient charts and other patient records to ensure treatment/service provided is within guidelines of the plan.
  • Review preauthorization paperwork to ensure the intended treatment meets the dental plan criteria and relevant program criteria.
  • Maintain accurate and detailed notes of work performed in the databases
  • Contact provider offices to obtain additional information as needed.
  • Respond to questions from internal and external customers in a through and timely manner utilizing communication that is easily understood by others.
  • Enter new authorization determinations, guidelines and denial reasons into company systems to ensure successful implementation of new clients
  • Utilize resources available to assess issues (set up, system, etc.) and locate appropriate resolution.
  • Utilize resources available to maintain current knowledge and understanding of dental plans and coverage provided.

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

Qualifications

  • Licensed Dental Hygienist in the state of Minnesota

Skills, Knowledge Abilities (SKA)             

  • Ability to communicate effectively (verbal and written) persons of diverse backgrounds and educational levels.
  • Excellent organization and interpersonal skills required.
  • Excellent problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution.
  • Skilled in working with others in a team environment.
  • Must be proficient in MS Office applications (Word, Excel, PowerPoint, and Access).

Experience

  • Minimum 5 years of experience in a clinical dental role or other similar related experience.
  • Knowledge of dental procedures, terminology and codes.

Mental and Physical Requirements        

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

Equal Opportunity Employer

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