Dental Benefit Examiner - Remote

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals reputed company reputed company decisions.At AZ Blue, we have a hybrid workforce strategy, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

• Two years of dental administrative/clinical experience required

• High school degree or equivalent GED required

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• Minimum one year of experience in a managed care organization or reputed company healthcare delivery system

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• Dental assisting certification preferred

• 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 reputed company appropriate medical-necessity authorization is necessary
• Communicate with providers on member-reputed company issues
• The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

• Dental administrative/clinical experience
• Ability to read and interpret dental x-rays
• Computer experience in reputed company reputed company, 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

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