The Senior Staff Dentist provides clinical leadership for utilization management and review programs to ensure appropriate dental care adjudication. They also participate in quality improvement initiatives, provider engagement, and peer review activities to maintain regulatory compliance and high standards of care.
The Staff Dentist reviews dental claims and prior authorization requests to ensure clinical necessity and adherence to benefit policies. They also engage in peer-to-peer consultations and collaborate with internal teams to maintain quality and regulatory standards.
The Claims Referral Specialist II is responsible for accurately processing dental claims, pre-authorizations, and referrals in accordance with regulatory guidelines and service level agreements. They will also collaborate with internal teams to resolve claim-related issues while maintaining high standards of quality and productivity.
The System Configuration Analyst will coordinate and execute claims and utilization management system projects while ensuring accurate benefit implementation. They will also collaborate with cross-functional teams to audit system rules, analyze complex scenarios, and maintain departmental policies.
The Quality Improvement Analyst will lead and support quality improvement projects while analyzing healthcare data to identify performance trends and gaps. They will facilitate cross-functional collaboration and present findings to leadership to drive measurable clinical and non-clinical outcomes.
Perform clinically sound reviews of dental claims, prior authorizations, and treatment requests to ensure evidence-based care. Collaborate with providers and leadership to maintain consistency in coverage determinations and support quality improvement initiatives.
Review dental claims and prior authorizations to ensure medical necessity and adherence to coverage guidelines. Collaborate with clinical leaders and providers to maintain consistency in clinical determinations and support quality initiatives.
