Clinical Review Dentist
About The Position
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Clinical Review Dentist is a production role that supports the dental director on claims review. Solid knowledge of dental procedures, terminology and related dental codes along with solid computer and communication skills are crucial to this role. Candidate must be available to work weekdays from 10:00 am – 7:00 pm CST and 8:00 am – 12:00 pm CST every other Saturday and Sunday.
Requirements
- Dental degree from an Accredited Dental School
- Active and unrestricted dental license
- 7+ years of experience in clinical dentistry
- 3+ years dental benefit plan experience with specific exposure to claim review and utilization management or comparable experience.
- Ability to pass a credentialing review for practice experience
- Proficient in Microsoft Word, Excel and PowerPoint
- Excellent business analytical and writing skills
Nice To Haves
- Active Dental License in Texas
- Experience with Dental Compliance related to Federal Regulations
Responsibilities
- Review of claims and supporting clinical data to provide accurate documentation for the dental director
- Accurate interpretation of radiographs, intra-oral photographs and clinical narratives
- Maintain organization and department defined standard of performance to meet metrics
- Communication with provider offices in accordance with compliance regulations to discuss adverse clinical determinations and to request missing information
- Independently manage individual queue assignments and workflow to meet deadlines, business needs and department and individual metrics
- Acts as a liaison between our dental directors and provider offices to maintain provider/member satisfaction
- Perform individual case review for appeals and grievances. The Appeals are in response to adverse determinations for dental services related to benefit design and coverage, medical necessity and the application of clinical criteria and dental policies, the Clinical Grievances are related to the quality of care provided by contracted dentists
- Participate in peer-to-peer calls with dental providers
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
Number of Employees
5,001-10,000 employees
