Dental Services Analyst

About the position

The Dental Services Analyst is responsible for the analysis of dental claims, radiographs, patient histories and other records to ensure consistent application of and compliance with policy and departmental guidelines. This position involves identifying and reporting on typical patterns of care, acting as a liaison between consultants, providers, members and operational departments to resolve unusual problems and complex cases, making independent decisions regarding benefit eligibility, providing expert analysis and testimony to corporate appeals and grievances, coordinating utilization review, and reporting savings while recommending procedural and policy changes to maintain or increase revenue.

Responsibilities

• Identifies and reports on typical patterns of care.
• Acts as a liaison between consultants, providers, members and operational departments to resolve unusual problems and complex cases.
• Makes independent decisions regarding benefit eligibility, including exceptions to policy as warranted.
• Provides expert analysis and testimony to corporate appeals and grievances.
• Coordinates utilization review, including scheduling consultants to ensure timeliness.
• Reports savings and recommends procedural and policy changes to maintain or increase revenue.

Requirements

• Requires BA/BS and minimum of 2 years of experience; or any combination of education and experience, which would provide an equivalent background.
• Dental assistant certificate required.

Nice-to-haves

• Current unrestricted license as a Dental Assistant or Dental Hygienist.
• Minimum of three years of experience in a clinical setting.
• Detailed knowledge of dental procedures, coding and contracts strongly preferred.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution