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Dental Claims Processor


This is a Contract position in Charleston, WV posted September 20, 2022.

Details: Dental Claims Processor Fully remote, Monday-Friday 20-30 hours/week, flexible hours 3-6 month contract Responsibilities: Review medical rationale in support of claims or claims eligibility.

Provide expert professional opinion to allow for benefit payment pursuant to the terms and conditions of the patient’s benefit contract.

Provide expert professional opinion on whether the patients condition meets applicable contract provisions for benefit payment.

Perform retrospective reviews of claims for hospital, dental, surgical, pharmacy and other allied health care services or treatment.

Review post treatment claims to provide professional expert opinion as to whether the content of the services provided was properly characterized and coded with respect to claims submitted for purposes of claims adjudication.

Provide alternative approaches that can improve practice performance while achieving similar or greater clinical quality.

Conduct peer to peer conversations with the attending physician or ordering providers.

Additional Skills & Qualifications: Doctoral degree in Dentistry e.g., D.M.D, D.D.S preferred.

A current, unrestricted license to practice dentistry issued by the State of Nebraska.

Board Certified by the American Board of General Dentistry.

Five (5) years of direct clinical care in private and/or academic practice.

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