Clinical Review Support Specialist

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Description

• Provides timely and accurate review and authorization of dental services based on eligibility and contract requirements • Read, interpret and evaluate x-rays, models and requests for major dental services • 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 • Respond to follow-ups • Provide customer service via the telephone to providers regarding clinical issues

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 well-being – mental, physical, 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 • Disability programs • Retirement and Stock Purchase programs to enhance financial security • 401(k) plan with employer-paid match • Employer-funded retirement account • Flexible work environment with a friendly and inclusive culture • Great Place to Work® Certified in Canada and the U.S.