[Hiring] Professional Dental Claim Specialist II @Cotiviti

Role Description

The Dental Claims Specialist reviews claims based on medical necessity, in accordance with client contracts, evaluates appeals, counsels providers, identifies providers with aberrant utilization patterns, provides clinical support for provider outreach, and acts as a clinical SME (or liaison) for internal entities.

• Review dental claims as assigned by the company.
• Authorize or deny claims based on medical necessity and eligibility, in accordance to contract language after clinical review; enter claim status into the system.
• Evaluate appeals and determine if proper documentation has been obtained to deny or approve claim; make further recommendations, request additional information, review charts, and make revised or reiterate claim decision.
• Review initial claims, appealed reviews, and pre-authorizations.
• Attend and participate in monthly consultant meetings, discussing claim review, technology, processes, innovations, specific procedure review of both old and new procedure codes, and any other pertinent business associated with the review of claims.

Qualifications

• Graduate of an ADA accredited dental school (DDS or DMD).
• Current and maintained unrestricted dental/dentist licensure in a U.S. state; board certification preferred if a specialist.
• 10 years of clinical dental experience preferred.
• Knowledge of general dentistry.
• Efficient computer skills.
• Organizational and time management skills.
• Ability to work with a team and independently to complete assigned tasks without supervision.
• Ability to make independent determinations on all types of dental claims.
• Excellent written and verbal communication skills.

Requirements

• This is a part-time role with flexible hours approximately 15-20 per week (early morning hours preferred).
• This role will work from home within the continental United States.
• Access to high-speed internet is required.
• After hours and/or weekend work may be required where necessary for major deliverables/deadlines.
• Must be able to sit and use a computer keyboard for extended periods of time.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.

Benefits

• Base compensation ranges from $34.00 to $45.75 per hour; specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
• This role is eligible for discretionary bonus consideration.
• Cotiviti offers a competitive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.