State Licensed Dental Utilization Processor

Job Summary

Leveraging dental clinical expertise, the full-time remote State Licensed Dental Utilization Processor will review dental x-rays and documentation to assess medical necessity for prior authorizations, ensuring compliance with client contracts and maintaining productivity standards.

Key responsibilities

• Conduct reviews of prior authorizations to determine treatment necessity in accordance with procedural guidelines
• Document approval decisions and maintain compliance with client contract requirements
• Evaluate service requests using national clinical criteria and maintain up-to-date knowledge of relevant regulations and policies

Required qualifications

• High School Diploma or equivalent required
• 2+ years of experience as a Dental Assistant or Dental Hygienist
• Dental Assistant certificate or 2 years of chairside assisting required
• 2 years of experience reviewing dental x-rays, models, and patient charts
• Proficiency with Microsoft Office and Windows-based applications