Dental Review Consultant

Job description

Ready to help us transform healthcare? Bring your true colors to blue. This is a part time position with an expectation of working 4 hours per week. The Role: This part time position is responsible for the clinical integrity, accuracy and consistency of our dental service reviews. The consultant evaluates documentation for clinical dental services submitted under various CDT codes to ensure they represent necessary and appropriate care for our members. These reviews can occur as pre-treatment estimates, claim submissions after the services have been completed or as appeals to initial denials. In performing these duties, the dental consultant will collaborate with cross-functional team members for consultation and advice, ensuring all reviews are conducted thoroughly and in accordance with our established guidelines. Collaboration is performed through various channels including but not limited to emails, phone calls, internal systems and meetings. Excellent communication skills are essential, as the consultant will also contact submitting providers as needed to clarify documentation or deliver determination notifications. Your Day to Day: 1. A primary responsibility is to evaluate t...