Dental Consultant, DDS or DMS Required

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Job description

Dental Consultant

"Per OSHA ETS/Federal Mandate, Wollborg Michelson does require all applicants to be able to provide proof that they are fully vaccinated from COVID prior to their start date, unless otherwise prohibited by law"

Detailed Description:

* Responsible for the review and final adjudication of claims and re-evaluation requests that require professional review.

* Processes claims and re-evaluation requests.

* Identifies the prognosis of submitted services and approves/denies based on standard guidelines.

* Returns provider's calls to discuss denials, policies and contractual limitations.

* Reviews and analyzes documentation related to patient complaints.

* Prepares draft responses to internal staff pertaining to enrollee and provider grievances and appeals.

* Provides assistance to Managing Dental Consultants and Legal department in arbitration cases.

* Requests refunds from providers.

* Performs miscellaneous duties as assigned.

Skills/Experience:

* A DDS or DMS degree from an accredited dental school.

* A minimum of 5 years of private practice dentistry.

* 2 or more years of training, processing and policy experience.

* Active and unencumbered license.

* Good standing with the Dental Licensing Board of the appropriate state.

* Strong organizational/time management skills and multi-tasking abilities.

* Detail oriented with analytic and problem-solving abilities.

* Customer service, conflict management and dispute resolution skills.

* Knowledge and application of English grammar, composition, editing and proofreading skills.

* Knowledge of health care industry issues preferred.