At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other's strengths and sharing in successes.
The Clinical Documentation Reviewer utilizes clinical expertise of dental procedures and practices to adjudicate prior authorization requests and claims.This position requires the incumbent to report to the Rancho Cordova, CA office and will not have opportunities for remote work.This position has a work schedule: Monday, Tuesday, and Thursday, 8am-5pm with a total of 24 hours.
How you will make an impact:
- Processes and/or adjudicates claims or treatment authorization requests that require professional review; reviews supporting documentation and adjudicate by applying dental standards.
- Identifies when additional information is necessary to make a claim or prior authorization determination and collaborate with internal and external parties to gather information where appropriate.
- Responds to inquiries from internal and/or external stakeholders regarding claim or prior authorization requests.
- Utilizes best practices in identification of potential Fraud, Waste, and Abuse (FWA) issues and report any identified issues to the appropriate party for resolution.
- Processes requests for re-evaluation.
- May review and analyze documentation related to patient quality-of-care complaints, state hearings, first level appeals, audits, Conlan cases, and maintain logs of resolved grievances as needed.
- Conducts or assist in developing seminars or training programs as needed.
- This list is not all-inclusive and you are expected to perform other duties as requested or assigned
What we look for:
- 2+ w/Bachelor's degree
- A DDS or DMD degree from an accredited dental school; A minimum of 5 years of private dentistry practice experience and an active, unencumbered dental license with the Dental Board required.
- Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
- Excellent analytical and problem solving skills.
- Excellent interpersonal, verbal, and written communication skills.
- Proficiency with the Microsoft Office Suite, including Word, Excel, Outlook, etc.
- Ability to adapt quickly in a fast-paced environment.
- Knowledge of Current Dental Terminology (CDT) codes, dental nomenclature, and industry trends.
- Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.
Please note, Delta Dental will not sponsor applicants for work visas for this position.
#LI-JB1At Delta Dental we:Promote accountability, integrity and collaboration:
Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.Foster professional development:
Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.Value customers and cultivate positive experiences:
Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.
If you think this sounds like you, let's chat. We would love to tell you more!
To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: @lifeatddins on Facebook
, @deltadentalins on Twitter
, and Delta Dental Ins. on LinkedIn
. ABOUT Delta Dental
Delta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we're all inspired to take exceptional care of our customers, providers and each other. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation. We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other classification protected by federal or state law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Proof of eligibility to work in the United States must be provided if selected for hire.