Clinical Review Support Specialist

Description:
• The Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements.
• Successful completion of the Clinical Review Specialist training program.
• Read, interpret, and evaluate x-rays, models, and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language.
• Resolve claim and prior authorization suspends that require UM Review.
• Consistently meet productivity requirements.
• Maintain audit score of 95% or greater.
• Pass the IRR quarterly.
• Communicate and work effectively with co-workers and Team Leads to coordinate workload to ensure all work is completed daily.

Requirements: • High School Diploma or equivalent. • 1 year dental assisting experience. • Previous dental insurance experience a plus. • Ability to read and interpret x-rays, dental models, photos, and/or patient charts. • Good interpersonal skills. • Ability to work without supervision. • Excellent oral and written communication skills. • Efficient PC skills (Word, Excel, Outlook). • Ability to prioritize and organize multiple tasks. • Ability to remain organized with multiple interruptions. • Knowledge of telephone systems. • Ability to work in excess of 40 hours in a week. • Required to attend additional training as required/deemed necessary.

Benefits:
• Excellent benefits and wellness programs to support the three pillars of well-being – mental, physical and financial.
• Generous vacation and sick time.
• Market-leading paid family, parental and adoption leave.
• Partially-paid sabbatical program.
• Medical plans.
• Company paid life and AD&D insurance as well as disability programs.
• Retirement and Stock Purchase programs including a 401(k) plan with an employer-paid match and employer-funded retirement account.
• A flexible work environment with a friendly, caring, collaborative and inclusive culture.

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