Senior Dental Review Specialist (RDH)

SKYGEN USA • Full-time • United States • $61.89k - $92.83k / year • 1w ago

Important things YOU should know:

Fully remote opportunity
Schedule: Monday – Friday – 8:00am – 5:00pm CST
Potential to Flex Schedule
Required weekend/holiday rotation
Willingness to flex schedule per business needs

What will YOU be doing? You will have the opportunity to review and authorize dental services in a timely and accurate manner, ensuring compliance with clinical criteria and contractual requirements. This includes coordinating administrative tasks and projects pertaining to the authorization process.

What will YOU be working on?

Review x-rays, patient charts, and other patient records to ensure the treatment/service provided falls within the plan guidelines and that the service was appropriate for the condition.
Review preauthorization paperwork to ensure the intended treatment meets the dental plan criteria and relevant program criteria.
Maintain accurate and detailed notes of work performed in the company system.

Assist the Manager and Team Lead with tasks related to policy and procedure creation, training materials, and capturing reporting requirements related to complaints and escalatory topics.
Act as back up for Team Lead position, assisting the Dental Review team with day-to-day problem resolution.

Respond to escalated questions and requests from internal and external customers in a thorough and timely manner
Work Client and internal created Onetime Tickets assigned to Dental Review from initial triage through execution of ticket request within specified departmental turnaround times.
Attend meetings with internal and external customers as subject matter experts in assigned markets.
Review monthly and quarterly reports for accuracy as assigned.
Utilize resources available to maintain current knowledge and understanding of dental plans and coverage.
Assist with training for new and existing team members and Dental Consultants.
Enter new authorization schedules, guidelines and denial reasons into company systems to ensure successful implementation of new clients.

Identify trends related to provider over or under utilization of dental services and refer on to internal resources for appropriate research and resolution.
Handle inventory management and clinical projects, provide day-to-day system trouble shooting and testing for implementations and upgrades.

Additional Responsibilities:

Perform system testing when required for system updates/upgrades and report findings (pass or fail) to appropriate area.
Act as liaison for department during implementation of new clients by attending cross functional meetings, understanding deliverables for department, communicating appropriately to team members, and ensuring completion of deliverables timely and accurately.

What qualifications do YOU need to have to be a GOOD candidate?

Required Level of Education, Licenses, and/or Certificates
- Registered Dental Hygienist – RDH ( must possess current unrestrictive license).
- High school diploma or equivalent.

Required Level of Experience
- 2+ years of experience in a clinical dental role or other related experience.

Required Knowledge, Skills, and Abilities
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
- Knowledge of dental procedures, terminology and codes.
- Excellent organizational skills to ensure required deadlines are met.
- Excellent problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution.
- Excellent verbal and written communication and relationship management skills.

What qualifications do YOU need to have to be a GREAT candidate?

Preferred Level of Education, License, and/or Certificates
- Advanced education and/or degree in Dental Assisting, Hygiene or similar field.

Preferred Level of Experience
- 3+ years of experience in a clinical dental role.

Preferred Knowledge, Skills, and Abilities
- Advanced administrative knowledge of the dental claim process.
- Excellent verbal and written skills.

The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range:

$61,885.00 - $92,827.00

Compensation Midpoint:

$77,356.00