Claims Examiner/Review Specialist - Team Lead

Join Delta Dental of Oklahoma, the leading dental benefits provider in the state of Oklahoma.

This position will work 40 hours per week.

Equal Opportunity Employer - Minority/Female/Disability/Veteran

JOB SUMMARY:

This position will be responsible for reviewing radiographs, narratives and periodontal charting in order to determine eligible benefits, process, pay, and/or deny claims and predeterminations within the delegated authority level, based on DDOK CDT and processing policy guidelines. Provide main communication link with DDOK and dental consultants regarding all aspects of claims review procedures and requirements. Provide training to dental consultants based on DDOK processing policies and CDT changes. Also responsible for processing all professional review and consultant review claims based on specialist and/or consultant determination. Contact providers and assist with incoming provider calls when additional information is needed or clarification required for specific claims. This position is also responsible for maintaining assigned workflow queues and ensuring all claims are processed within set Standards of Performance.

MINIMAL QUALIFICATIONS:

• High School Diploma or equivalent
• Three (3) or more years of chairside dental assistant experience or Certified Dental Assistant.
• Ability to data enter 4500 KSPH alpha & 5000 KSPH numeric.
• A thorough understanding of dental procedure codes and dental terminology.
• Must be able to determine correct procedure benefit and qualifications when reviewing documentation and/or dental radiographs that have been submitted with all claims and predeterminations.
• Ability to view radiographic images with accuracy.
• Working knowledge of Microsoft Word, Outlook, and Excel.

ADDITIONAL QUALIFICATIONS:

• Knowledge of the aQden claims processing system.
• A thorough understanding of DDOK's processing policies and how they apply to all contracts in force.
• Expanded chairside dental assisting duties that includes radiographic safety certification/working knowledge of radiographs.

Current Openings for Claims Examiner/Review Specialist Team Lead Jobs at Delta Dental of Oklahoma