Utilization Management Clinical Dental Processor

Responsibilities: Evaluate dental service requests and prior authorizations to determine medical necessity based on national clinical criteria. Document approval decisions and maintain productivity standards by completing 13 to 18 cases per hour.

Requirements: Requires a High School Diploma/GED and certification as a Dental Assistant or Hygienist with 1-2 years of experience reviewing dental x-rays and charts. Must have a reliable internet connection and proficiency in Microsoft Office for this remote position.

Key skills: Clinical Judgment, Dental X-ray Review, Utilization Management, Microsoft Office, Professional Communication, Time Management, Critical Thinking, Patient Chart Review, Prior Authorization, Medical Coding, Detail Oriented, Collaboration

Keywords: Utilization Management, Dental Assistant, Dental Hygienist, HCPCS, CPT, CDT, ICD-10, Medicare, Medicaid, X-Ray Certification, Prior Authorization, Clinical Review, Microsoft Teams, Microsoft Outlook, Windows-based Applications, Healthcare Insurance, Clinical Scripts