Clinical Review Specialist - Dental

Job Summary

A company is looking for a Clinical Review Specialist.

Key Responsibilities:

• Read, interpret, and analyze clinical documentation for benefit determination
• Respond to inquiries regarding clinical claim or prior authorization requests
• Engage with provider offices to obtain necessary information for review

Required Qualifications:

• 3+ years of clinical dental experience with a High School Diploma
• Certificate or higher in Dental Assisting required
• Working knowledge of claims processing flow and adjudication
• Understanding of dental procedures, CDT, and related concepts
• Knowledge of Delta Dental products, policies, claims, eligibility, and underwriting guidelines