Medical Claims Review Manager jobs in Scranton, PA

Description

POSITION SUMMARY

The Dental Claims Processor/Prior Authorization Specialist assesses insurance claims for patient visits to a dental office. These claims could include any procedure performed by a dentist on a patient’s teeth, which might cover everything from essential cleanings to surgical procedures.  The Dental Claims Processor/Prior Auth Specialist ensures each claim is complete and the treatment received meets all the criteria for coverage as laid out by the insurance company. The Dental Claims Processor/Prior Auth Specialist will need an understanding of the terminology that a dentist would use and the criteria that insurance companies use to assess claims. The Dental Claims Processor/Prior Auth Specialist will act as the point of contact providing dental management assistance between providers and insurance companies. This position will work directly with insurance companies to submit required dental procedure prior authorization to ensure procedure coverage and timely payment

REPORTING RELATIONSHIPS

This position reports to the Director of Dental Operations. 

DUTIES & ESSENTIAL JOB FUNCTIONS  

While living and demonstrating our Core Values, the Dental Claims Processor/Prior Authorization Specialist will:

• Adjudicate dental claims based on prescribed guidelines for the purpose of processing claims according to policy and contract requirements. Including online/electronic claims, requesting necessary information, completing claim adjustment requests and referencing benefit policies
• Monitor claim turnaround time reports and daily checks for claim accuracy
• Request any needed information to constituents in order to effectively and efficiently resolve outstanding claims issues. 
• Review chart documentation to ensure patient dental policy guidelines, prioritize authorization requests accordingly to urgency
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payor dental policy guidelines, confirm accuracy of dental procedure codes, contact patients to discuss authorization status 

Requirements

• 3-5 years of dental claims processing and prior authorization experience
• Experience with Dexis and Dentrix dental billing software
• Able to multi-task without losing quality work
• Knowledge of dental terminology and radiographs
• High school diploma or equivalent 
• Proficiency in Word, Excel, PowerPoint and e-mail 
• Must be reliable and punctual 
• Must have attention to detail 
• Must be able to perform effectively in a fast-paced environment with many changing priorities 
• Must be professional and customer service oriented to deliver quality excellent care 
• Ability to work independently and with a team 
• Professional written and verbal communication and interpersonal skills 
• Willingness to work a flexible schedule and cover at other clinics when necessary