US National – Telecommute
The incumbent in this position is responsible for the review and final adjudication of claims, pretreatment estimates, pre-determinations and re-evaluation requests for orthodontic treatment that require professional review. Provides assistance to the Dental Director, performs miscellaneous duties as assigned.
How you will make an impact:
Processes prior authorization requests, claims, and requests for re-evaluation for orthodontic services.
Identifies the prognosis of submitted services and approves/denies based on standard guidelines.
Returns provider’s calls to discuss denials, policies and contractual limitations.
Reviews and analyzes documentation related to patient complaints.
Prepares draft responses to internal staff pertaining to enrollee and provider grievances and appeals.
Provides assistance to the Dental Director and Legal department in arbitration cases.
Requests refunds from providers.
Performs miscellaneous duties as assigned.
What we look for:
A DDS or DMS degree from an accredited dental school.
Post graduate degree from an accredited orthodontic program.
A minimum of 5 years of private practice dentistry.
Good standing with the Dental Licensing Board of the appropriate state; holds active and unencumbered license.
Strong organizational/time management skills and multi-tasking abilities.
Detail oriented with analytic and problem-solving abilities.
Customer service, conflict management and dispute resolution skills.
Knowledge and application of English grammar, composition, editing and proofreading skills.
Knowledge of health care industry issues preferred.
Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.
Knowledge of Washington Medicaid policies and procedures.
PC literacy required; MSOffice skills (Outlook, Word, Excel, PowerPoint).
Benefits and perks:
12 days starting vacation plus 11 holidays and your birthday off!
Multiple medical insurance options: 100% paid or low cost premiums
100% paid dental insurance
100% paid vision insurance
Onsite gym and/or gym discount and fitness incentive
Culture of learning: substantial tuition reimbursement to improve your skills
Career growth: we love promoting from within
Strong commitment to work/life balance
Social responsibility and volunteer opportunities
If you think this sounds like you, let’s chat. We would love to tell you more!
ABOUT Delta Dental
As the first company to specialize in dental insurance, we are passionate about oral health and its importance to future generations. Our core purpose is the advancement of oral health care to our customers, partners and consumers through dental insurance programs and philanthropic efforts.
We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.
Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer,…
Consulting , Healthcare Consultant , Insurance Claims , Dental , Doctor & Practitioner