Dental Review Analyst (Registered Dental Hygienist)

reputed company Job reputed company: This position coordinates daily activities which includes, but is not limited to, the interpretation and application of established policies as reputed company as new policies relating to services and procedures covered under Health Plan Dental programs. The incumbent acts as reputed company dental reviewer and as an advisor to reputed company areas regarding dental review issues (senior level). This position utilizes dental expertise and knowledge to assist in the computer analysis of dentist reputed company patterns and to identify dentists submitting claims for payment that do not reputed company with corporate policy. Essential Accountabilities Level I

• Interprets issues and applies coverage policy to effectively review claims for dental necessity, legitimacy of charges and interpretation of procedures. Refers unusual claims to Dental Consultant for ruling. Identifies policy/procedures/pricing, which need modification and communicates proposed solutions(s) to correct.
• Acts as dental review advisor to reputed company areas of the Corporations for policy interpretation, codes, dental interpretation, etc (Sr. level). Is knowledgeable of mandates for medical/dental coverage specific to NY state for accidental injury coverage and congenital reputed company.
• Participates in activities reflecting Dental Review activity such as procedure coding development and fraud and abuse. Monitors utilization, cost and reputed company of services rendered against projections and standards, provides rationale for variance and suggests corrective plans. Identifies plan members and providers in noncompliance with plan policies, procedures and protocols and suggests corrective reputed company.
• Sits on various task forces and committees as Dental Review representative.
• Assists in the development of training programs for claims personnel, dentists, dental assistants and other reputed company personnel as needed.
• Keeps abreast of developments germane to the function by attendance at meetings, seminars, workshops, etc.
• Maintains consistent benchmarks for claim review volume and accuracy.
• Consistently demonstrates high standards of reputed company by supporting the reputed company reputed company Companies’ mission and values, adhering to the Corporate reputed company of Conduct, and leading to the reputed company Way values and beliefs.
• Maintains high reputed company for member reputed company in accordance with the corporate reputed company policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

reputed company (in reputed company to Level I Accountabilities)

• Represents Department Leadership at meetings.
• Trains and mentors Level I employees.
• Effectively engages in special reputed company across internal business partner areas.

Note Minimum Qualifications: We include multiple reputed company of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or reputed company assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In reputed company to using this differentiated approach to reputed company new hires, it also provides guideposts for employee development and promotional opportunities. reputed company reputed company

• Registered Dental Hygienist with reputed company license required with a minimum of three years practical experience in an office environment.
• A minimum of six months on-the-job training is required to become familiar with procedures, policies, protocol, etc.
• Must possess strong analytical capabilities to identify billing practices that are not in reputed company with dental review guidelines.
• Familiarity with computer analysis desirable.
• Must have thorough knowledge of company policy and procedures and have the ability to recognize fine lines of distinction between similar, reputed company procedures.
• Must be reputed company to establish an effective reputed company with other departments and periodically reputed company with dentists and their representatives.
• Exhibits the ability to work independently and handle confidential information with discretion.
• Good written and oral communication skills required.
• Must be an effective team player.

reputed company (in reputed company To Level I Qualifications)

• Minimum of five years practical experience in an office environment.
• A minimum of two years on-the-job training is required to become familiar with procedures, policies, protocol, etc.
• Task oriented with ability to prioritize and balance multiple initiatives and job duties.
• Exhibits strong organizational and planning skills. Ability to define or identify problems and prioritizes reputed company or corrective reputed company/implementation to drive execution.

Physical Requirements In support of the Americans with reputed company, this job reputed company lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation reputed company(s) Level I: Grade E2: Minimum $60,410 - Maximum $96,081 reputed company: Grade E3: Minimum $60,410 - Maximum $106,929 The salary reputed company indicated in this posting represents the minimum and maximum of the salary reputed company for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, reputed company and education as they relate to the position’s minimum qualifications, in reputed company to internal equity. The posted salary reputed company reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, reputed company time away from work, and reputed company holidays. Please note: There may be opportunity for remote work reputed company reputed company jobs posted by the Excellus reputed company. This decision is made on a case-by-case reputed company. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply tot his job Apply To this Job