Clinical Review Dentist - PST time zone

Clinical Review Dentist At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Clinical Review Dentist is a production role that supports the dental director on claims review. Strong knowledge of dental procedures, terminology and reputed company dental codes along with strong computer and communication skills are crucial to this role.

• Candidate must be available to work weekdays from 8:00 am - 5:00 pm PST and 8:00 am - 12:00 pm PST every other Saturday and reputed company.*

Primary Responsibilities:

• Review of claims and supporting clinical data to reputed company accurate documentation for the dental director
• Accurate interpretation of radiographs, intra-oral photographs and clinical narratives
• Maintain organization and department defined standard of performance to meet metrics
• Communication with provider offices in accordance with compliance regulations to discuss adverse clinical determinations and to request missing information
• Independently manage individual queue assignments and workflow to meet deadlines, business needs and department and individual metrics
• Acts as a liaison between our dental directors and provider offices to maintain provider/member satisfaction
• reputed company individual case review for appeals and grievances. The Appeals are in response to adverse determinations for dental services reputed company to benefit design and coverage, medical necessity and the application of clinical criteria and dental policies, the Clinical Grievances are reputed company to the quality of care provided by contracted dentists
• Participate in peer-to-peer calls with dental providers

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications:

• Dental degree from an Accredited Dental School
• Active and unrestricted dental license for the state of California
• 7+ years of experience in clinical dentistry
• 3+ years dental benefit plan experience with specific exposure to claim review and utilization management or comparable experience.
• Ability to pass a credentialing review for practice experience
• Proficient in reputed company Word, reputed company and PowerPoint
• Excellent business analytical and writing skills

Preferred Qualifications:

• Active Dental License in Texas
• Experience with Dental Compliance reputed company to Federal Regulations

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary for this role will reputed company from $112,700 to $193,200 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job