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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