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Clinical Review Specialist

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Milwaukee, WI

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Job Description The Clinical Review Specialist I is responsible for timely and accurate review and authorization of dental services based on eligibility and contract requirements. JOB DUTIES AND RESPONSIBILITIES: Participation and successful completion of the Clinical Review Specialist training program. Review and authorize major dental services based on medical necessity and eligibility, in accordance with contract language. Consistently meet Level 1 productivity requirements (10 authorizations per hour after 6 months). Maintain acceptable audit and IRR scores within departmental guidelines. Communicate and work effectively with co-workers and Market Leads to coordinate workload to ensure all work is completed daily. Represent DentaQuest in a professional manner at all times. Communicate to management ways to improve processes and productivity of company. Other duties as assigned. Required Skills Ability to read and interpret x-rays, dental models, photos, and\/or patient charts. Good interpersonal skills. Ability to work independently. Excellent oral and written communication skills. Efficient PC skills (Word, Excel, Access). Ability to prioritize and organize multiple tasks. Ability to remain organized with multiple interruptions. Required Experience 6 months of dental assisting experience or degree in dental field; previous dental insurance experience.

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