We are seeking a Dentist Reviewer responsible for the clinical evaluation of pre-authorizations and claims, managing and reviewing post-operative cases.
Responsibilities
- Review and evaluate clinical data for pre-authorization and claims
- Make final determinations following guidelines
- Oversee the process of submitting, tracking and resolving pre-authorization and claims
- Review post-operative cases to ensure compliance with established dental standards and guidelines
- Work closely with the administrative team to ensure proper documentation
- Provide feedback on the clinical outcomes and treatment plans for post-op cases, ensuring they align with the best practice.
- Accuracy and timelines in the review and processing of pre-authorizations and claims.
Requirements
- Minimum of five years of clinical dental practice experience, preferably in general or specialty dentistry.
- Doctor of Dental Surgery or Doctor of Medicine in Dentistry degree.
- Active and unrestricted dental license of Puerto Rico required.
- Good Standing Certificate
- Excellent communication and organizational skills
- Experience working with Utilization Management software and claims adjudication platforms – highly preferred
- Bilingual
Job Types: Full-time, Part-time, Contract
Work Location: In person
