Dental Benefit Examiner (Hybrid/Remote)
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. This position is remote... within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests. REQUIRED QUALIFICATIONS Required Work Experience Two years of dental administrative/clinical experience required Required Education High school degree or equivalent GED required Required Licenses NA Required Certifications NA PREFERRED QUALIFICATIONS Preferred Work Experience Minimum one year of experience in a managed care organization or related healthcare delivery system Preferred Education NA Preferred Licenses NA Preferred Certifications Dental assisting certification preferred Essential Job Functions and Responsibilities Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions Processes referral requests in accordance with clinical review criteria Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary Communicate with providers on member-related issues Competencies REQUIRED COMPETENCIES Required Job Skills Dental administrative/clinical experience Ability to read and interpret dental x-rays Computer experience in Microsoft Excel, Word, Outlook Required Professional Competencies Knowledge of Medicaid and Medicare regulations and guidelines Knowledge of dental coding and terminology Knowledge of HIPPA regulations Required Leadership Experience and Competencies Effective time management skills Effective interpersonal and communication skills Ability to prioritize work tasks to adhere to deadlines and identified time frames Ability to work cooperatively, positively, and collaboratively in a team environment PREFERRED COMPETENCIES Preferred Job Skills NA Preferred Professional Competencies NA Preferred Leadership Experience and Competencies NA Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply Apply Job! For more such jobs please click here!