Branch Review Specialist jobs in Roanoke, VA

Position Summary: 

Seeking Dental Hygienist to review claims with the submitted diagnostic material to make proper benefit determinations based on group contracts and DeltaUSA and departmental established guidelines/policies. Responsible to clear out queues on a daily basis and to pend appropriate claims for additional information. Refers claims to dental consultants for review.  This position is located in Roanoke, VA and candidate must be willing to live in the area.  

Essential Functions:

• Reviews diagnostic material (i.e. x-rays, periodontal charting, etc.) to determine appropriate benefits.
• Adjudicate claim benefit review requests in a timely manner.
• Refers claims to dental consultant for review when diagnostic materials do not appear to support the procedure requested.
• Follows DeltaUSA guidelines and departmental guidelines/policies for claims processing.
• Works in team concept with the CCU and other departments within Delta Dental.
• Maintain accuracy and production numbers to meet department expectations.
• Audited to ensure KPI’s are met monthly.

Qualifications/Education/Experience: 

• Registered Dental Hygienist (RDH) or Dental office manager/dental insurance experience required. 
• Knowledge interpreting dental x-rays.
• The ability to follow established procedures with moderate decision-making. 
• Extensive computer knowledge/skills. 
• Strong interpersonal and communication skills.
• The ability to focus for long periods of time.
• A positive attitude with ability to adapt to change and learn new things.