Dental Benefit Examiner

Blue Cross Blue Shield of Arizona • Phoenix, AZ

5d • Remote

About The Position

The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.

Requirements

• Two years of dental administrative/clinical experience required
• High school degree or equivalent GED required
• Dental administrative/clinical experience
• Ability to read and interpret dental x-rays
• Computer experience in Microsoft Excel, Word, Outlook
• Knowledge of Medicaid and Medicare regulations and guidelines
• Knowledge of dental coding and terminology
• Knowledge of HIPPA regulations
• Effective time management skills
• Effective interpersonal and communication skills
• Ability to prioritize work tasks to adhere to deadlines and identified time frames
• Ability to work cooperatively, positively, and collaboratively in a team environment

Nice To Haves

• Minimum one year of experience in a managed care organization or related healthcare delivery system
• Dental assisting certification preferred

Responsibilities

• Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions
• Processes referral requests in accordance with clinical review criteria
• Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns
• Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing
• Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary
• Communicate with providers on member-related issues

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees